Psychology & Neuroscience

© 2018 American Psychological Association 2018, Vol. 11, No. 3, 317–328

1983-3288/18/$12.00 http://dx.doi.org/10.1037/pne0000118

Impact of Age and Schooling on Performance on the Brief

Cognitive Screening Battery: A Study of Elderly Residents in the
City of Rio de Janeiro, Brazil

Verônica C. Araujo, Flávia P. Furtado

Christina M. B. Lima, Secretaria Especial de Envelhecimento Saudável e
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

and Eduarda N. B. Barbosa Qualidade de Vida (SESQV), Prefeitura da Cidade

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Pontifícia Universidade Católica do Rio de Janeiro do Rio de Janeiro, Rio de Janeiro, Brazil

Helenice Charchat-Fichman
Pontifícia Universidade Católica do Rio de Janeiro

The objective of this study was to investigate the impact of age and schooling on Brief
Cognitive Screening Battery (BCSB) performance in elderly residents in the city of Rio de
Janeiro, Brazil. The sample was composed of 470 elderly individuals, all of whom were
evaluated using the BCSB. The results were analyzed by groups that were divided by age
and schooling. Analyses of variances (ANOVAs) were performed to examine differences
in performance between the age and schooling groups and interactions between age and
schooling. Correlations between cognitive variables, age, and schooling were also analyzed.
The sample consisted of 420 women (89.4%) and 50 men (10.6%). The mean age was
72.77 ⫾ 7.06 years, with average schooling of 9.54 ⫾ 5.32 years. The ANOVA showed
that elderly individuals who were older than 80 years of age presented worse performance
on memory tasks compared with the younger age groups. With regard to schooling, elderly
individuals with low schooling presented worse performance on the Verbal Fluency and
Clock Drawing tests and on the Mini Mental State Examination. The two-way ANOVA
revealed a significant Age ⫻ Schooling interaction for Mini Mental State Examination
scores. The Age ⫻ Schooling interaction impacted performance of the elderly in the
evaluation of global cognitive function. The present results indicated a dissociation, in
which age affected memory function, and schooling affected other cognitive functions.

Keywords: age, schooling, cognition, Brief Cognitive Screening Battery, elderly

The aging population is a worldwide phe-
nomenon, but it is more striking in developing
countries where this transformation is occurring
This article was published Online First August 2, 2018.
Verônica C. Araujo, Christina M. B. Lima, and Eduarda
N. B. Barbosa, Department of Psychology, Pontifícia Universi-
dade Católica do Rio de Janeiro; Flávia P. Furtado, Secretaria
Especial de Envelhecimento Saudável e Qualidade de Vida
(SESQV), Prefeitura da Cidade do Rio de Janeiro, Rio de Janeiro,
Brazil; Helenice Charchat-Fichman, Department of Psychology;
Pontifícia Universidade Católica do Rio de Janeiro.
Correspondence concerning this article should be ad-
dressed to Verônica C. Araujo, Department of Psychology,
Pontifícia Universidade Católica do Rio de Janeiro, R. Mar-
quês de São Vicente, 225 - Gávea, Rio de Janeiro - RJ
22430-060, Brasil. E-mail: veronica_c_araujo@yahoo
.com.br
317
more rapidly and more recently than in devel-
oped countries (Figueiredo, Assis, Silva, Dias,
& Mancini, 2013; Noroozian, Shakiba, & Iran-
nejad, 2014). This aging process has been ac-
companied by an increase in life expectancy and
consequently a higher incidence of aging-
related diseases, especially neurodegenerative
diseases that have a tremendous economic and
social impact (Figueiredo et al., 2013; Paddick
et al., 2014; Steibel, Olchik, Yassuda, Finger, &
Gomes, 2016).
A major focus of recent studies has been on
the early detection of neurodegenerative dis-
eases, such as Alzheimer’s disease. Early diag-
nosis allows patients and caregivers to have a
better quality of life and allows access to treat-
 318 ARAUJO ET AL.
ments that may slow the course of the disease
(Chang et al., 2014; James, Grace, Thomas, &
Combrinck, 2015; Li & Hsu, 2015; Paddick et
al., 2014; Sposito, Neri, & Yassuda, 2015).
However, for a precise diagnosis to be made, it
is necessary to know the ways in which cogni-
tive decline occurs during aging and the factors
that may influence performance on neuropsy-
chological tests in the elderly.
Cognitive changes that occur as a conse-
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quence of aging are well reported in the litera-
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ture, such as changes in processing speed, work-
ing memory, and executive function. Recent
years have seen a significant increase in the
prevalence of dementias (Castro-Costa et al.,
2011; Duff & Ramezani, 2015; Soares et al.,
2012; Sposito et al., 2015). Schooling is another
important factor that affects performance on
cognitive tests, which has been reported by sev-
eral studies in various countries (Castro-Costa
et al., 2011; James et al., 2015; Soares et al.,
2012; Steibel et al., 2016). Formal education
leads to an increase in neuroplasticity and
greater complexity of neural networks (Paddick
et al., 2014).
Low levels of education and advanced age
are considered risk factors for pathological cog-
nitive decline, and these factors can, in many
cases, lead to false-positives on cognitive
screening exams (Chang et al., 2014; Li & Hsu,
2015; Paddick et al., 2014; Soares et al., 2012).
To prevent or reduce the incidence of such
false-positives or false-negatives, valid screen-
ing tests need to utilize normative data by con-
sidering age, schooling, or both. This strategy of
interpreting the results is even more relevant in
countries with large sociodemographic hetero-
geneity (Duff & Ramezani, 2015; Steibel et al.,
2016), such as Brazil.
Few studies of cognitive screening tests have
provided normative data that are stratified by
age and schooling. In the case of the Mini
Mental State Examination (MMSE; i.e., the
most widely used screening test worldwide), the
main studies have been performed by Berto-
lucci, Brucki, Campacci, and Juliano (1994);
Brucki, Nitrini, Caramelli, Bertolucci, and Oka-
moto (2003), and Laks, Baptista, Contino, de
Paula, and Engelhardt (2007). Bertolucci et al.
(1994) found no significant differences between
groups of subjects of different ages, including
young adults, and the elderly; the sample was
only divided by schooling (Bertolucci et al.,
1994). The study by Brucki et al. (2003) also
included youngsters in their sample, and the
sample was divided by schooling (Brucki et al.,
2003). The study by Laks et al. (2007) was
performed only with elderly individuals, and the
sample was divided by age and schooling. How-
ever, the sample did not consist of individuals
with more than 8 years of schooling, and the
elderly were older than 84 years of age (Laks et
al., 2007). The creation of normative data that
consider older ages, more years of schooling,
and less broad groups of these variables is nec-
essary for the early detection of cognitive de-
cline in the Brazilian context.
The Brief Cognitive Screening Battery
(BCSB) was developed by Nitrini et al. (1994).
It is a tool for cognitive screening that is not
greatly affected by schooling. In the study by
Nitrini et al. (1994), the performance of subjects
with mild or moderate dementia was compared
with healthy subjects who were matched by age,
schooling, and gender. Participants were be-
tween 50 and 85 years old and had at least 4
years of schooling. The study concluded that the
BCSB has a good ability to discriminate be-
tween patients and controls (Nitrini et al.,
1994). In another study, the BCSB was used
to differentiate subjects with Alzheimer’s dis-
ease from controls. The average schooling of
the participants was 11 years. The BCSB also
presented good diagnostic accuracy, mainly in
the late memory and verbal fluency tests (Nitrini
et al., 2007).
Nitrini et al. (2008) evaluated the impact of
age and schooling on BCSB performance. The
study included adults who were 19 – 81 years of
age and excluded people who were illiterate. A
negative correlation between BCSB perfor-
mance and age was found, and a positive cor-
relation between BCSB performance and
schooling was found (Nitrini et al., 2008). In
another study, BCSB performance was evalu-
ated in elderly individuals with depression com-
pared with elderly individuals with mild
Alzheimer’s disease and healthy elderly indi-
viduals. The results demonstrated the ability of
the BCSB to differentiate these three cognitive
profiles (Novaretti, Radanovic, & Nitrini,
2012). More recently, the BCSB was applied to
frail elderly patients who were treated at a ge-
riatric outpatient clinic. In both studies, the
BCSB proved to be a good instrument to dif-
ferentiate subjects with and without dementia
 IMPACT OF AGE AND SCHOOLING ON BCSB
(Fichman et al., 2013; Fichman-Charchat et al.,
2016). Two other epidemiological studies that
used the BCSB to identify and differentiate
cases of dementia were those of Herrera, Cara-
melli, Silveira, and Nitrini (2002) and Nitrini,
Caramelli, Herrera, Bahia, et al. (2004). Both
studies were conducted in the city of Catan-
duva, Brazil. In addition to identifying cases of
dementia, these studies concluded that older age
and lower schooling were associated with worse
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cognitive performance in the elderly and a
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greater propensity to develop neurodegenera-
tive disease (Herrera et al., 2002; Nitrini, Cara-
melli, Herrera, Porto, et al., 2004). The objec-
tive of the present study was to investigate the
impact of age and schooling on performance on
the BCSB in elderly residents in the city of Rio
de Janeiro, Brazil.
Method
Participants
The sample consisted of 470 elderly individ-
uals, ⬎60 years old and of both sexes, who
attended a social program that was offered by
the government of Rio de Janeiro (Casas de
Convivência e Lazer para Idosos). The subjects
were divided into five groups of schooling (0
years–illiterates, 1– 4 years, 5– 8 years, 9 –11
years, and ⱖ12 years) and three age groups
(60 – 69 years, 70 –79 years, and ⱖ80 years).
The inclusion criteria were participants who
were older than 60 years old, who agreed to
participate in the study, and who understood
and signed an informed consent form that was
approved by the Research Ethics Committee
(opinion no. 965.264). The exclusion criteria
were the existence of functional impairment
(assessed by Lawton’s Instrumental Activities
of Daily Living Scale, score ⱕ5) and severe
hearing or visual impairment that would make
communication difficult.
Procedures
The evaluation lasted ⬃1 h and was held in a
quiet room. The questionnaires assessing the
independence of the elderly were duly filled out
by the accompanying persons who were indi-
cated by the subject. They participated in this
study as researchers, psychologists, and psy-
chology students, all attending weekly supervi-
sion.
319
Instruments
The BCSB consisted of the Memory of Fig-
ure test, Semantic Verbal Fluency test (animals
category), Clock Drawing test. Lawton’s Instru-
mental Activities of Daily Living Scale, the
Pfeffer Functional Activities Questionnaire, and
the Geriatric Depression Scale (GDS-15) were
used to describe the functional profile of the
elderly. The Mini Mental State Examination
(MMSE) was used to measure general cognitive
functioning.
The Memory of Figures test consisted of a
sheet of 10 simple drawings of common objects
(i.e., shoe, house, comb, key, airplane, bucket,
turtle, book, spoon, and tree) that should be
named by the examiner and then recalled im-
mediately by the subject. The subject was then
presented with the drawings two more times and
then asked each time to remember and say as
many drawings as possible. An interval of 5 min
then elapsed when other tests were performed,
and the subject was asked again to remember
and say the figures. Finally, the recognition task
was performed with a sheet of paper that con-
tained both the 10 figures above and 10 other
distracting figures. The subject was asked to
recognize which figures were presented previ-
ously (Nitrini et al., 1994).
In the Semantic Verbal Fluency test (animals
category), the subjects were asked to say as
many animals as possible, as quickly as possi-
ble, in 1 min (Borod, Goodglass, & Kaplan,
1980; Brucki, Fleury Malheiros, Okamoto, &
Bertolucci, 1997).
In the Clock Drawing test, the subjects were
asked to draw a clock with all the numbers
inside and the watch hands marking 2:45 (2 h
and 45 min). Scores were calculated based on
the criteria adapted from Sunderland and co-
workers (1989; Mendes-Santos, Mograbi, Spen-
ciere, & Charchat-Fichman, 2015; Nitrini et al.,
1994).
The MMSE has been used to assess global
cognitive function in Brazil (Brucki et al., 2003;
Folstein, Folstein, & McHugh, 1975). In the pres-
ent study, we used the score of 30 (MEEM-30)
and 35 (MEEM-35). The score 35 was formed
by the score of MEEM-30 added to the result of
the task of inverse spelling of the word
“WORLD” (maximum of 5 points).
Lawton’s Instrumental Activities of Daily
Living Scale and the Pfeffer Functional Activ-
 320 ARAUJO ET AL.

ities Questionnaire assess the independence of
the elderly with regard to instrumental activities
of daily living. For the Lawton scale, the elderly
subjects and their companion responded to the
questionnaire. For the Pfeffer questionnaire,
only the elderly subject’s companion responded
(Dos Santos & Virtuoso Júnior, 2008; Dutra,
Ribeiro, Pinheiro, de Melo, & Carvalho, 2015;
Lawton & Brody, 1969; Pfeffer, Kurosaki,
Harrah, Chance, & Filos, 1982). The GDS-15 is
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(44.6%, n ⫽ 209) were widowed, 73 (15.3%)
were single, 97 (20.8%) were married, and 91
(19.3%) were divorced.
With regard to age groups, 33.8% of the
sample were 60 – 69 years old, 48.87% were
70 –79 years old, and 17.4% were ⱖ80 years
old. With regard to schooling, 3.6% had 0 years
of schooling, 19.6% had 1– 4 years of school-
ing, 18.7% had 5– 8 years of schooling, 17.4%
had 9 –11 years of schooling, and 40.6%

a shortened version of the original 30-item in- had ⱖ12 years of schooling. The means, SDs,
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strument, which has presented good sensitivity
and specificity for screening depressive symp-
toms (Paradela, Lourenço, & Veras, 2005; Ye-
savage et al., 1982).
Data Analysis
The data were analyzed using SPSS 20.0
software. Descriptive statistics were initially
performed. Frequencies, means, SDs, and per-
centiles were analyzed according to age and
schooling groups for each BSCB measure.
Two-way analysis of variance (ANOVA) fol-
lowed by the Bonferroni post hoc test was used
to verify significant differences between age
and schooling groups and interactions for each
BSCB measure. Pearson’s correlation analysis
was performed to determine correlations be-
tween age, schooling, and cognition. Values of
p ⬍ .05 were considered statistically significant.
Results
The sample consisted of 420 women (89.4%)
and 50 men (10.6%). The mean age was 72.77 ⫾
7.06 years, and the mean schooling was 9.54 ⫾
5.32 years. The majority of the elderly subjects
and percentiles for the BCSB for the total sam-
ple are presented in Table 1. The means, SDs,
and percentiles for the GDS, Lawton scale, and
Pfeffer questionnaire are presented in Table 2.
The means and SDs for the BCSB stratified
by age and schooling groups are presented in
Tables 3 through 5. The data in Table 3 are from
the 60- to 69-year-old group. The data in Table
4 are from the 70- to 79-year-old group. The
data in Table 5 are from the ⱖ80-year-old
group.
The ANOVA indicated that some of the mem-
ory tasks were impacted solely by age. For inci-
dental memory, immediate memory, learning, and
delayed recall memory test, the performance of
the 60- to 69-year-old group was significantly
different from the ⱖ80-year-old group (p ⬍ .01).
The 70- to 79-year-old group presented better
performance than the ⱖ80-year-old group on the
same tasks. For recognition, a significant differ-
ence was observed between the 60- to 69-year-old
group and ⱖ80-year-old group (p ⬍ .05). Pear-
son’s correlation analysis indicated that incidental
memory, immediate memory, learning, delayed
recall memory test, and recognition were nega-
tively correlated with age (p ⬍ .01; Table 6).

Table 1
Means, SDs, and Percentiles for the BCSB (n ⫽ 470)
Percentile Nom. I.M. Im.M. Lear. D.R.M. Rec. C.D.T. V.F. ME30 ME35
10 10.00 4.00 6.00 7.00 5.00 9.00 3.00 9.00 21.00 22.00
25 10.00 5.00 7.00 8.00 7.00 10.00 4.00 12.00 22.00 25.00
50 10.00 6.00 8.00 9.00 8.00 10.00 5.00 15.00 25.00 29.00
75 10.00 6.00 9.00 10.00 9.00 10.00 7.00 19.00 27.00 32.00
90 10.00 7.00 9.90 10.00 10.00 10.00 9.00 22.00 29.00 34.00
Mean 9.84 5.50 7.79 8.53 7.49 9.77 5.49 15.57 24.77 28.17
SD .65 1.46 1.48 1.38 2.10 .69 2.13 4.89 3.21 4.51
Note. BCSB ⫽ Brief Cognitive Screening Battery; Nom. ⫽ Nomination; I.M. ⫽ Incidental Memory; Im.M. ⫽ Immediate
Memory; Lear. ⫽ Learning; D.R.M. ⫽ Delayed Recall Memory test; Rec. ⫽ Recognition; C.D.T. ⫽ Clock Drawing test;
V.F. ⫽ Verbal Fluency test; ME30 ⫽ MMSE-30; ME35 ⫽ MMSE-35.
 IMPACT OF AGE AND SCHOOLING ON BCSB 321

Table 2

Note. Nom. ⫽ Nomination; I.M. ⫽ Incidental Memory; Im.M. ⫽ Immediate Memory; Lear. ⫽ Learning; D.R.M. ⫽ Delayed Recall Memory test; Rec. ⫽ Recognition; C.D.T. ⫽
21.25 (2.60)
26.56 (4.16)
26.52 (3.65)
29.04 (3.85)
30.12 (3.23)
M (SD)
ME35
Means, SDs, and Percentiles for the Lawton Scale
and Pfeffer Questionnaire (n ⫽ 470)
Lawton Lawton
Percentile GDS elderly companion Pfeffer

21.00 (2.33)
23.92 (2.93)
23.72 (2.72)
25.37 (2.59)
26.18 (2.46)
10 .00 18.00 17.00 .00

M (SD)
ME30
25 1.00 20.00 19.00 .00
50 2.00 21.00 20.00 .00
75 4.00 21.00 21.00 1.00
90 7.00 21.00 21.00 4.00
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Mean 2.86 20.19 19.64 1.27

12.38 (1.77)
13.04 (4.50)
13.28 (4.63)
16.19 (4.84)
17.96 (4.76)
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SD 3.02 1.57 2.64 3.06

M (SD)
V.F.
Note. GDS ⫽ Geriatric Depression Scale.

There was age effect in the difference between

3.50 (1.31)
4.71 (2.10)
5.48 (2.24)
6.04 (2.14)
5.97 (2.03)
learning and delayed recall (F ⫽ 4.42, p ⬍ .05).

M (SD)
C.D.T.
The difference is higher for those aged 80 years
and over when compared with the other age strata
groups (p ⬍ .05).
The impact of schooling was evaluated in tasks

10.00 (.00)
9.92 (.40)
9.80 (.50)
9.89 (.32)
9.91 (.29)
M (SD)
that were related to executive function and global
cognitive function. In the Clock Drawing test, Rec.
significant differences were found between the
group with 0 years of schooling and the other
groups (all p ⬍ .01), with the exception of
8.63 (1.06)
7.28 (2.11)
7.60 (1.66)
8.15 (1.63)
7.88 (1.77)
Means and SDs for the 60 – 69 Year Old Group Stratified by Schooling (n ⫽ 159)

Clock Drawing test; V.F. ⫽ Verbal Fluency test; ME30 ⫽ MMSE-30; ME35 ⫽ MMSE-35.
M (SD)
D.R.M.

the group with 1– 4 years of schooling, in which

the difference only approached statistical signifi-
cance (p ⫽ .09). Performance on the Clock Draw-
ing test was significantly different between the
8.32 (1.31)
8.56 (1.16)

8.64 (1.46)

group with 1– 4 years of schooling and the group

8.88 (.83)

9.22 (.75)
M (SD)
Lear.

with 9 –11 years of schooling (p ⫽ .019) and

between the group with 1– 4 years of schooling
and the group with ⱖ12 years of schooling (p ⬍
.01). In the Semantic Verbal Fluency test, signif-
7.75 (1.04)
7.84 (1.55)
8.04 (1.27)
8.04 (1.29)
8.07 (1.55)
M (SD)

icant differences were found between the group

Im.M.

with ⱖ12 years of schooling and all of the other

groups (0 years, 1– 4 years, and 5– 8 years, all
p ⬍ .01; 9 –11 years, p ⫽ .03). Pearson’s corre-
lation analysis indicated that performance on both
5.44 (1.42)
5.84 (1.46)
5.44 (1.31)
5.84 (1.46)
6.00 (.76)
M (SD)

the Clock Drawing test and Semantic Verbal Flu-

I.M.

ency test was positively correlated with years of

schooling (p ⬍ .01).
Performance on the MMSE-30 indicated signif-
icant differences between all schooling groups
9.75 (.71)
9.76 (.52)
9.88 (.33)
9.96 (.19)
9.81 (.70)
M (SD)
Nom.

(p ⬍ .01), with the exception of the comparison

between the group with 5– 8 years of schooling
and the group with 9 –11 years of schooling (p ⫽
1.00). The MMSE-35 results were similar to the
9–11 (n ⫽ 27)
ⱖ12 (n ⫽ 74)
1–4 (n ⫽ 25)
5–8 (n ⫽ 25)

MMSE-30 but with a less marked difference be-

Schooling
(years)
0 (n ⫽ 8)

tween the group with 9 –11 years of schooling and

Table 3

the group with ⱖ12 years of schooling (p ⬍ .05).

Pearson’s correlation analysis indicated that per-
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322

Table 4
Means and SDs for the 70 –79 Year Old Group Stratified by Schooling (n ⫽ 229)
Schooling Nom. I.M. Im.M. Lear. D.R.M. Rec. C.D.T. V.F. ME30 ME35
(years) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD)
0 (n ⫽ 6) 9.50 (.84) 5.67 (1.86) 7.33 (1.97) 8.17 (1.17) 6.83 (1.72) 9.83 (.41) 3.17 (1.94) 12.00 (2.37) 18.83 (3.13) 19.83 (5.08)
1–4 (n ⫽ 50) 9.70 (1.02) 5.76 (1.65) 7.76 (1.56) 8.34 (1.60) 7.24 (2.34) 9.64 (1.03) 4.66 (1.88) 12.86 (4.06) 22.40 (3.04) 24.42 (4.49)
5–8 (n ⫽ 44) 9.86 (.77) 5.66 (1.22) 7.84 (1.43) 8.48 (1.17) 7.64 (2.06) 9.70 (.70) 5.50 (2.01) 15.14 (4.87) 24.95 (2.86) 29.05 (3.83)
9–11 (n ⫽ 39) 9.92 (.35) 5.38 (1.41) 8.05 (1.50) 8.67 (1.58) 7.46 (2.04) 9.85 (.43) 5.46 (2.22) 15.90 (5.23) 25.13 (2.68) 28.97 (3.74)
ⱖ12 (n ⫽ 90) 9.98 (.15) 5.29 (1.47) 7.88 (1.32) 8.78 (1.25) 7.88 (1.95) 9.81 (.60) 6.30 (2.25) 17.67 (4.57) 26.48 (2.74) 30.50 (3.46)
Note. Nom. ⫽ Nomination; I.M. ⫽ Incidental Memory; Im.M. ⫽ Immediate Memory; Lear. ⫽ Learning; D.R.M. ⫽ Delayed Recall Memory test; Rec. ⫽ Recognition; C.D.T. ⫽
Clock Drawing test; V.F. ⫽ Verbal Fluency test; ME30 ⫽ MMSE-30; ME35 ⫽ MMSE-35.
ARAUJO ET AL.

Table 5
Means and SDs for the ⱖ80 Year Old Group Stratified by Schooling (n ⫽ 82)
Schooling Nom. I.M. Im.M. Lear. D. R. M. Rec. C.D.T. V.F. ME30 ME35
(years) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD) M (SD)
0 (n ⫽ 3) 9.67 (.58) 5.33 (2.52) 7.67 (2.08) 8.33 (.58) 7.00 (1.73) 10.00 (.00) 2.67 (2.08) 13.00 (4.58) 20.67 (4.51) 20.67 (4.51)
1–4 (n ⫽ 17) 9.47 (.94) 4.71 (1.45) 7.12 (1.58) 8.00 (1.90) 6.06 (2.90) 9.47 (1.18) 4.47 (1.46) 13.12 (4.20) 23.06 (3.13) 26.24 (4.70)
5–8 (n ⫽ 19) 9.84 (.38) 5.26 (1.15) 7.21 (1.58) 8.05 (1.39) 6.89 (1.70) 9.84 (.50) 5.05 (1.78) 14.11 (3.91) 24.26 (3.12) 27.00 (4.50)
9–11 (n ⫽ 16) 9.44 (1.55) 5.44 (1.67) 7.13 (1.41) 8.06 (1.18) 6.25 (2.75) 9.56 (.89) 5.25 (1.57) 14.81 (4.29) 24.13 (2.87) 27.75 (3.82)
ⱖ12 (n ⫽ 27) 10.00 (.00) 4.96 (1.58) 7.15 (1.68) 8.04 (1.53) 6.81 (2.65) 9.44 (1.28) 5.63 (1.86) 16.19 (4.16) 24.67 (3.54) 28.52 (4.55)
Note. Nom. ⫽ Nomination; I.M. ⫽ Incidental Memory; Im.M. ⫽ Immediate Memory; Lear. ⫽ Learning; D.R.M. ⫽ Delayed Recall Memory; Rec. ⫽ Recognition; C.D.T. ⫽ Clock
Drawing test; V.F. ⫽ Verbal Fluency test; ME30 ⫽ MMSE-30; ME35 ⫽ MMSE-35.
 IMPACT OF AGE AND SCHOOLING ON BCSB 323

Table 6
BCSB Performance Stratified by Age (n ⫽ 470)
Group 1 Group 2 Group 3
Cognitive variable M (SD) M (SD) M (SD) Performance
Nomination 9.84 (.56) 9.87 (.63) 9.73 (.85) G2 ⬎ G1 and G3
Incidental memory 5.72 (1.40) 5.49 (1.47) 5.09 (1.50) G1 ⬎ G2 ⬎ G3ⴱ
Immediate memory 8.01 (1.43) 7.86 (1.44) 7.17 (1.56) G1 ⬎ G2 ⬎ G3ⴱ
Learning 8.69 (1.28) 8.59 (1.38) 8.05 (1.47) G1 ⬎ G2 ⬎ G3ⴱ
Delayed recall memory 7.82 (1.77) 7.59 (2.07) 6.57 (2.48) G1 ⬎ G2 ⬎ G3ⴱ
Recognition 9.89 (.35) 9.76 (.71) 9.59 (1.02) G1 ⬎ G2 ⬎ G3ⴱ
⬎ ⬎ G3
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Clock Drawing test 5.59 (2.15) 5.56 (2.22) 5.07 (1.79) G1 G2

Verbal Fluency test 15.87 (5.08) 15.68 (4.95) 14.68 (4.22) G1 ⬎ G2 ⬎ G3
This document is copyrighted by the American Psychological Association or one of its allied publishers.

MMSE-30 25.04 (2.91) 24.86 (3.35) 23.99 (3.31) G1 ⬎ G2 ⬎ G3

MMSE-35 28.36 (4.17) 28.35 (4.68) 27.26 (4.60) G1 ⬎ G2 ⬎ G3
Note. BCSB ⫽ Brief Cognitive Screening Battery; ME30 ⫽ MMSE-30; ME35 ⫽ MMSE-35. Group 1, 60 – 69 years old;
Group 2, 70 –79 years old; Group 3, ⱖ80 years old.
ⴱ
p ⬍ .05, significant difference between groups (one-way analysis of variance).

formance on the MMSE-30 and MMSE-35 was
positively correlated with years of schooling (p ⬍
.01; Table 7).
The ANOVA indicated an Age ⫻ Schooling
interaction only for global cognitive function on
the MMSE-35 (F(8, 471 ⫽ 2.30, p ⫽ .02). Figure
1 shows the results of the multifactorial analysis of
the BCSB data that indicated the effects of the
Age ⫻ Schooling interaction on global cognitive
function.
Discussion
The present study investigated the effects of
age and schooling on performance on the BCSB
in elderly residents in the city of Rio de Janeiro.
Most studies that have used the BCSB included
outpatient populations or mixed elderly and
young adults in the same sample. Few studies
have included elderly participants who were
stratified by levels of schooling. The present
study evaluated BCSB performance in commu-
nity-dwelling elderly individuals with all levels
of schooling.
We found that sociodemographic factors,
such as age and schooling, differentially impact
cognitive function. Age affected immediate
memory but had no effect on executive function
or measures of global cognitive function. One

Table 7
BCSB Performance Stratified by Schooling (n ⫽ 470)
Group 1 Group 2 Group 3 Group 4 Group 5
Cognitive variable M (SD) M (SD) M (SD) M (SD) M (SD) Performance
Nomination 9.65 (.70) 9.67 (.89) 9.86 (.59) 9.84 (.74) 9.92 (.45)
G2 ⬍ G5ⴱ
Incidental memory 5.76 (1.48) 5.48 (1.59) 5.63 (1.28) 5.41 (1.41) 5.46 (1.51)
G1 ⬎ G3 ⬎ G2 ⬎ G5 ⬎ G4
Immediate memory 7.59 (1.50) 7.66 (1.56) 7.76 (1.44) 7.87 (1.45) 7.85 (1.49)
G4 ⬎ G5 ⬎ G3 ⬎ G2 ⬎ G1
Learning 8.53 (.94) 8.27 (1.58) 8.41 (1.22) 8.73 (1.33) 8.62 (1.39)
G4 ⬎ G5 ⬎ G1 ⬎ G3 ⬎ G2
Delay Recall memory 7.71 (1.61) 7.03 (2.42) 7.47 (1.88) 7.45 (2.16) 7.73 (2.02)
G5 ⬎ G1 ⬎ G3 ⬎ G4 ⬎ G2
Recognition 9.94 (.24) 9.68 (.94) 9.76 (.61) 9.80 (.53) 9.79 (.67)
G1 ⬎ G4 ⬎ G5 ⬎ G3 ⬎ G2
Clock Drawing test 3.24 (1.60) 4.64 (1.85) 5.40 (2.01) 5.61 (2.08) 6.08 (2.12)
G1 ⬍ G3, G4, and G5ⴱ
G2 ⬍ G4 and G5ⴱ
Verbal Fluency test 12.35 (2.42) 12.96 (4.16) 14.39 (4.63) 15.78 (4.90) 17.57 (4.60) G1 ⬍ G4, and G5ⴱ
G2 ⬍ G4, and G5ⴱ
G3 ⬍ G5ⴱ
MMSE-30 20.18 (3.00) 22.93 (3.07) 24.45 (2.90) 25.01 (2.69) 26.10 (2.81) G1 ⬍ G2 ⬍ G3 ⬍ G4 ⬍ G5ⴱ
MMSE-35 20.65 (3.74) 25.34 (4.51) 27.89 (4.06) 28.76 (3.78) 30.07 (3.59) G1 ⬍ G2 ⬍ G3 ⬍ G4 ⬍ G5ⴱ
Note. BCSB ⫽ Brief Cognitive Screening Battery; ME30 ⫽ MMSE-30; ME35 ⫽ MMSE-35.Group 1, 0 years of
schooling; Group 2, 1– 4 years of schooling; Group 3, 5– 8 years of schooling; Group 4, 9 –11 years of schooling; Group
5, ⱖ12 years of schooling.
ⴱ
p ⬍ .05, significant difference between groups (one-way analysis of variance).
 This document is copyrighted by the American Psychological Association or one of its allied publishers.
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324
ARAUJO ET AL.

indicated the effects of the Age ⫻ Schooling interaction on global cognitive function.
Figure 1. Multifactorial analysis of the Brief Cognitive Screening Battery (BCSB) data that
 IMPACT OF AGE AND SCHOOLING ON BCSB
explanation for the impact of age on memory
task performance is the negative effect of age on
immediate memory and learning (Castro-Costa
et al., 2011; Liu et al., 2011; Sposito et al.,
2015; Tripathi, Kumar, Bharath, Marimuthu, &
Varghese, 2014). Such deleterious effects on
memory may be explained by decreases in brain
volume, neurotransmitter levels, or concentra-
tions of brain metabolites (Collinson, Fang,
Lim, Feng, & Ng, 2014). Immediate memory is
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essential for learning, and immediate memory
This document is copyrighted by the American Psychological Association or one of its allied publishers.
deficits have a negative impact on learning. In
the present study, performance on the memory
tasks was only significantly different for the
oldest group (ⱖ80 years of age). The subjects in
this group were as old as 96 years of age, which
is 20 years older than the majority of the sam-
ple.
Previous studies have reported that learning
ability worsens as individuals age (Avila,
Lopes, Nakano, & Bottino, 2016; Soares et al.,
2012). In Avila et al. (2016), standards were
defined for memory assessment using the Fuld
Object Memory Evaluation (that was developed
to be less influenced by schooling and can mea-
sure learning ability and episodic memory with-
out the use of word lists) and Memory of Fig-
ures Test. The results of Avila et al. (2016)
indicated a significant effect of age, but unlike
in the Memory of Figures Test, schooling was
also a determining factor in the outcome.
Soares et al. (2012) used the BCSB to eval-
uate the impact of sociodemographic vari-
ables on cognition in a sample of community-
dwelling elderly individuals. They also found
an effect of age, which predicted worse per-
formance in memory tasks. Similar to the
present study, memory was unaffected by
schooling. Other studies investigated the ef-
fects of schooling on BCSB performance, in-
dicating that the Memory of Figures Test is
valid for populations with different levels of
schooling, including illiterate individuals
with no schooling (Fichman-Charchat et al.,
2016; Nitrini, Caramelli, Herrera, Porto, et
al., 2004; Takada et al., 2006).
In contrast to other studies, in the present
study, performance on tasks that evaluated ex-
ecutive function (i.e., Clock Drawing test and
Semantic Verbal Fluency test) and global cog-
nitive function (i.e., MMSE-30 and MMSE-35)
was only affected by schooling and not by age.
Schooling, especially literacy, improves visu-
325
ospatial strategies, planning, and semantic lex-
ical access, all of which are necessary for good
performance on the Clock Drawing test, Seman-
tic Verbal Fluency test, and assessments of
global cognitive function, such as the MMSE
(Mokri et al., 2012; Moraes et al., 2013). Years
of schooling can also improve synaptic-
dendritic connections, myelination, and neuro-
genesis (Noroozian et al., 2014); thus, leading
to better cognitive skills, such as language, se-
mantic memory, attention, mental organization,
and processing speed (Nielsen & Jørgensen,
2013). These abilities are strongly related to
executive function, which may explain the
worse performance in less-educated elderly in-
dividuals.
Cognitive reserve is another important factor
that is related to schooling. Older people with
more years of schooling have more cognitive
reserve that may protect them against the dele-
terious effects of aging and neurodegenerative
disease. Cognitive reserve is not fully formed in
school; it develops and improves throughout
life. People with more years of schooling also
tend to have jobs and engage in activities that
stimulate cognition; thus, increasing their cog-
nitive reserve with advancing age (Noroozian et
al., 2014; Paddick et al., 2014). In the present
study, Pearson’s correlation analysis indicated a
strong influence (all p ⬍ .01) of schooling on
performance on tasks that require visuocon-
structive skills, planning, mental organization,
and a broad vocabulary. Mokri et al. (2012)
compared performance in illiterate seniors with
older people who had learned to read and write,
regardless of whether they attended school. The
results of the Clock Drawing test, Verbal Flu-
ency test, and MMSE indicated that elderly
individuals with relatively low levels of school-
ing performed significantly better than elderly
individuals who were illiterate (i.e., 0 years of
schooling). One explanation for this is that the
ability to read and write facilitates performance
on written tasks that require the use of a pencil
(Mokri et al., 2012; Soares et al., 2012).
Notably, in the present study, the Age ⫻
Schooling interaction affected only global cog-
nitive function, evaluated by the MMSE-35. In
the other tasks, cognitive reserve that was gen-
erated by schooling may have protected the
subjects against the negative effects of aging on
cognition, and younger individuals, even those
who had only a few years of schooling, may
 326 ARAUJO ET AL.
have performed better because they were still
young relative to elderly individuals who were
older than 80 years of age.
One limitation of the present study was the
relatively low number of illiterate elderly indi-
viduals with 0 years of schooling and very old
individuals (i.e., ⱖ80 years of age). A relevant
factor may be the lack of available tools to
assess the rate of illiteracy that have been
adapted and validated for the Brazilian popula-
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tion. Another limitation may be that some of the
This document is copyrighted by the American Psychological Association or one of its allied publishers.
subjects in the present study who were not con-
sidered illiterate for group assignment were not
actually able to understand text that was slightly
more complex than, for example, “Close your
eyes” on the MMSE. Lastly, the recruitment of
subjects may have been limited by accessibility,
in which some elderly individuals are unable to
attend activities in an autonomous and indepen-
dent way; thus, making this age group less
accessible for recruitment.
The present results indicate that the BCSB is
a good tool for cognitive screening that is gen-
erally not influenced by interactions between
age and schooling. Normative data that are
stratified by age and schooling are needed to
better understand the performance of older
adults with different levels of schooling and
improve the accuracy of this instrument.
References
Avila, R., Lopes, M. A., Nakano, E. Y., & Bottino,
C. M. (2016). Normative data of Fuld Object
Memory Evaluation test for Brazilian elderly pop-
ulation. Arquivos de Neuro-Psiquiatria, 74, 138–
144. http://dx.doi.org/10.1590/0004-282X20
150200
Bertolucci, P. H., Brucki, S. M., Campacci, S. R., &
Juliano, Y. (1994). O Mini-Exame do Estado Men-
tal em uma população geral. Impacto da escolari-
dade [The Mini-Mental State Examination in an
outpatient population: influence of literacy]. Ar-
quivos de Neuro-Psiquiatria, 52, 1–7. http://dx.doi
.org/10.1590/S0004-282X1994000100001
Borod, J. C., Goodglass, H., & Kaplan, E. (1980).
Normative data on the Boston Diagnostic Aphasia
Examination, parietal lobe battery, and the Boston
Naming Test. Journal of Clinical Neuropsychol-
ogy, 2, 209–215. http://dx.doi.org/10.1080/
01688638008403793
Brucki, S. M. D., Malheiros, S. M., Okamoto, I. H.,
& Bertolucci, P. H. (1997). Dados normativos para
o teste de fluência verbal categoria animais em
nosso meio [Normative data: Category verbal flu-
ency]. Arquivos de Neuro-Psiquiatria, 55, 56– 61.
http://dx.doi.org/10.1590/S0004-282X199700
0100009
Brucki, S. M., Nitrini, R., Caramelli, P., Bertolucci,
P. H., & Okamoto, I. H. (2003). Sugestões para o
uso do mini-exame do estado mental no Brasil
[Suggestions for utilization of the mini-mental
state examination in Brazil]. Arquivos de Neuro-
Psiquiatria, 61, 777–781. http://dx.doi.org/10
.1590/S0004-282X2003000500014
Castro-Costa, E., Dewey, M. E., Uchôa, E., Firmo,
J. O., Lima-Costa, M. F., & Stewart, R. (2011).
Trajectories of cognitive decline over 10 years in a
Brazilian elderly population: The Bambuí Cohort
Study of Aging. Cadernos de Saude Publica,
27(Suppl. 3), S345–S350. http://dx.doi.org/10
.1590/S0102-311X2011001500004
Chang, J., Tse, C. S., Leung, G. T., Fung, A. W.,
Hau, K. T., Chiu, H. F., & Lam, L. C. (2014). Bias
in discriminating very mild dementia for older
adults with different levels of education in Hong
Kong. International Psychogeriatrics, 26, 995–
1010. http://dx.doi.org/10.1017/S1041610214
000234
Collinson, S. L., Fang, S. H., Lim, M. L., Feng, L., &
Ng, T. P. (2014). Normative data for the repeatable
battery for the assessment of neuropsychological
status in elderly Chinese. Archives of Clinical Neu-
ropsychology, 29, 442– 455. http://dx.doi.org/10
.1093/arclin/acu023
Dos Santos, R. L., & Virtuoso Júnior, J. S. (2008).
Confiabilidade da versão Brasileira da Escala de
Atividades Instrumentais de Vida Diária [Reliabil-
ity of the Brazilian version of the Scale of Instru-
mental Activities of Daily Living]. Revista Brasil-
eira em Promoção da Saúde, 21, 290–296. http://
dx.doi.org/10.5020/18061230.2008.p290
Duff, K., & Ramezani, A. (2015). Regression-based
normative formulae for the Repeatable Battery for
the Assessment of Neuropsychological Status for
older adults. Archives of Clinical Neuropsychol-
ogy, 30, 600– 604. http://dx.doi.org/10.1093/arclin/
acv052
Dutra, M. C., Ribeiro, R. S., Pinheiro, S. B., de Melo,
G. F., & Carvalho, G. A. (2015). Accuracy and
reliability of the Pfeffer Questionnaire for the Bra-
zilian elderly population. Dementia & Neuropsy-
chologia, 9, 176–183. http://dx.doi.org/10.1590/
1980-57642015DN92000012
Fichman, H. C., Fernandes, C. S., Oliveira, R. M.,
Caramelli, P., Aguiar, D., & Novaes, R. (2013).
Predomínio de Comprometimento Cognitivo Leve
Disexecutivo em idosos atendidos no ambulatório
da geriatria de um hospital público terciário na
cidade do Rio de Janeiro [Disexecutive Mild Cog-
nitive Impairment predominance in elderly as-
sisted at geriatric clinic into public hospital in Rio
 IMPACT OF AGE AND SCHOOLING ON BCSB
de Janeiro]. Revista Neuropsicologia Latinoameri-
cana, 5, 31– 40.
Fichman-Charchat, H., Miranda, C. V., Fernandes,
C. S., Mograbi, D., Oliveira, R. M., Novaes, R., &
Aguiar, D. (2016). Brief Cognitive Screening Bat-
tery (BCSB) is a very useful tool for diagnosis of
probable mild Alzheimer=s disease in a geriatric
clinic. Arquivos de Neuro-Psiquiatria, 74, 149–
154. http://dx.doi.org/10.1590/0004-282X2015
0202
Figueiredo, C. S., Assis, M. G., Silva, S. L., Dias,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
R. C., & Mancini, M. C. (2013). Functional and
This document is copyrighted by the American Psychological Association or one of its allied publishers.
cognitive changes in community-dwelling elderly:
Longitudinal study. Brazilian Journal of Physical
Therapy, 17, 297–306. http://dx.doi.org/10.1590/
S1413-35552012005000094
Folstein, M. F., Folstein, S. E., & McHugh, P. R.
(1975). “Mini-mental state”. A practical method
for grading the cognitive state of patients for the
clinician. Journal of Psychiatric Research, 12,
189–198. http://dx.doi.org/10.1016/0022-3956
(75)90026-6
Herrera, E., Jr., Caramelli, P., Silveira, A. S., &
Nitrini, R. (2002). Epidemiologic survey of de-
mentia in a community-dwelling Brazilian popu-
lation. Alzheimer Disease and Associated Disor-
ders, 16, 103–108. http://dx.doi.org/10.1097/
00002093-200204000-00007
James, K. A., Grace, L. K., Thomas, K. G., & Com-
brinck, M. I. (2015). Associations between CAM-
COG-R subscale performance and formal educa-
tion attainment in South African older adults.
International Psychogeriatrics, 27, 251–260.
http://dx.doi.org/10.1017/S1041610214002233
Laks, J., Baptista, E. M., Contino, A. L., de Paula,
E. O., & Engelhardt, E. (2007). Mini-Mental State
Examination norms in a community-dwelling sam-
ple of elderly with low schooling in Brazil. Cad-
ernos de Saude Publica, 23, 315–319. http://dx.doi
.org/10.1590/S0102-311X2007000200007
Lawton, M. P., & Brody, E. M. (1969). Assessment
of older people: Self-maintaining and instrumental
activities of daily living. The Gerontologist, 9,
179–186. http://dx.doi.org/10.1093/geront/9
.3_Part_1.179
Li, C. L., & Hsu, H. C. (2015). Cognitive function
and associated factors among older people in Tai-
wan: Age and sex differences. Archives of Geron-
tology and Geriatrics, 60, 196–200. http://dx.doi
.org/10.1016/j.archger.2014.10.007
Liu, K. P., Kuo, M. C., Tang, K. C., Chau, A. W., Ho,
I. H., Kwok, M. P., . . . Chu, L. W. (2011). Effects
of age, education and gender in the Consortium to
Establish a Registry for the Alzheimer’s Disease
(CERAD)-Neuropsychological Assessment Bat-
tery for Cantonese-speaking Chinese elders. Inter-
national Psychogeriatrics, 23, 1575–1581. http://
dx.doi.org/10.1017/S1041610211001153
327
Mendes-Santos, L. C., Mograbi, D., Spenciere, B., &
Charchat-Fichman, H. (2015). Specific algorithm
method of scoring the Clock Drawing Test applied
in cognitively normal elderly. Dementia & Neuro-
psychologia, 9, 128–135. http://dx.doi.org/10
.1590/1980-57642015DN92000007
Mokri, H., Ávila-Funes, J. A., Le Goff, L., Ruiz-
Arregui, L., Gutierrez Robledo, L. M., & Amieva,
H. (2012). Self-reported reading and writing skills
in elderly who never attended school influence
cognitive performances: Results from the
Coyoacán cohort study. The Journal of Nutrition,
Health & Aging, 16, 621– 624. http://dx.doi.org/10
.1007/s12603-012-0070-8
Moraes, A. L., Guimarães, L. S., Joanette, Y., de
Mattos Pimenta Parente, M. A., Fonseca, R. P., &
Almeida, R. M. (2013). Effect of aging, education,
reading and writing, semantic processing and de-
pression symptoms on verbal fluency. Psicologia:
Reflexão e Crítica, 26, 680– 690. http://dx.doi.org/
10.1590/S0102-79722013000400008
Nielsen, T. R., & Jørgensen, K. (2013). Visuocon-
structional abilities in cognitively healthy illiterate
Turkish immigrants: A quantitative and qualitative
investigation. The Clinical Neuropsychologist, 27,
681– 692. http://dx.doi.org/10.1080/13854046
.2013.767379
Nitrini, R., Brucki, S. M. D., Smid, J., Carthery-
Goulart, M. T., Renato, A., Areza-Fegyveres, R.,
. . . Mansur, L. L. (2008). Influence of age, gender
and educational level on performance in the Brief
Cognitive Battery-Edu. Dementia & Neuropsycho-
logia, 2, 114–118. http://dx.doi.org/10.1590/
S1980-57642009DN20200007
Nitrini, R., Caramelli, P., Herrera, E., Jr., Bahia,
V. S., Caixeta, L. F., Radanovic, M., . . . Taka-
hashi, D. Y. (2004). Incidence of dementia in a
community-dwelling Brazilian population. Alzhei-
mer Disease and Associated Disorders, 18, 241–
246.
Nitrini, R., Caramelli, P., Herrera, E., Jr., Porto, C. S.,
Charchat-Fichman, H., Carthery, M. T., . . . Lima,
E. P. (2004). Performance of illiterate and literate
nondemented elderly subjects in two tests of long-
term memory. Journal of the International Neuro-
psychological Society, 10, 634– 638. http://dx.doi
.org/10.1017/S1355617704104062
Nitrini, R., Caramelli, P., Porto, C. S., Charchat-
Fichman, H., Formigoni, A. P., Carthery-Goulart,
M. T., . . . Prandini, J. C. (2007). Brief cognitive
battery in the diagnosis of mild Alzheimer’s dis-
ease in subjects with medium and high levels of
education. Dementia & Neuropsychologia, 1, 32–
36. http://dx.doi.org/10.1590/S1980-57642008
DN10100006
Nitrini, R., Lefèvre, B. H., Mathias, S. C., Caramelli,
P., Carrilho, P. E., Sauaia, N., . . . Scaff, M. (1994).
Testes neuropsicológicos de aplicação simples
 328 ARAUJO ET AL.
para o diagnóstico de demência [Brief and easy-
to-administer neuropsychological tests in the diag-
nosis of dementia]. Arquivos de Neuro-Psiquia-
tria, 52, 457– 465. http://dx.doi.org/10.1590/
S0004-282X1994000400001
Noroozian, M., Shakiba, A., & Iran-nejad, S. (2014).
The impact of illiteracy on the assessment of cog-
nition and dementia: A critical issue in the devel-
oping countries. International Psychogeriatrics,
26, 2051–2060. http://dx.doi.org/10.1017/
S1041610214001707
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Novaretti, T. M. S., Radanovic, M., & Nitrini, R.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
(2012). Screening for cognitive impairment in late
onset depression in a Brazilian sample using the
BBRC-Edu. Dementia & Neuropsychologia, 6,
85–90. http://dx.doi.org/10.1590/S1980-5764201
2DN06020004
Oliveira, E. M., Silva, H. S., Lopes, A., Cachioni, M.,
Falcão, D. V., Batistoni, S. S., . . . Yassuda, M. S.
(2015). Atividades Avançadas de Vida Diária
(AAVD) e desempenho cognitivo entre idosos
[Advanced Activities of Daily Living (AADL) and
cognitive performance among older adults]. Psico-
USF, 20, 109–120. http://dx.doi.org/10.1590/
1413-82712015200110
Paddick, S. M., Longdon, A., Gray, W. K., Dotchin,
C., Kisoli, A., Chaote, P., & Walker, R. (2014).
The association between educational level and de-
mentia in rural Tanzania. Dementia & Neuropsy-
chologia, 8, 117–125. http://dx.doi.org/10.1590/
S1980-57642014DN82000006
Paradela, E. M., Lourenço, R. A., & Veras, R. P.
(2005). Validação da escala de depressão geriátrica
em um ambulatório geral [Validation of geriatric
depression scale in a general outpatient clinic].
Revista de Saude Publica, 39, 918–923. http://dx
.doi.org/10.1590/S0034-89102005000600008
Pfeffer, R. I., Kurosaki, T. T., Harrah, C. H., Jr.,
Chance, J. M., & Filos, S. (1982). Measurement of
functional activities in older adults in the commu-
nity. Journal of Gerontology, 37, 323–329. http://
dx.doi.org/10.1093/geronj/37.3.323
Soares, L. M., Cachioni, M., Falcão, D. V., Batistoni,
S. S., Lopes, A., Neri, A. L., & Yassuda, M. S.
(2012). Determinants of cognitive performance
among community dwelling older adults in an im-
poverished sub-district of São Paulo in Brazil.
Archives of Gerontology and Geriatrics, 54, e187–
e192. http://dx.doi.org/10.1016/j.archger.2011.11
.014
Sposito, G., Neri, A. L., & Yassuda, M. S. (2015).
Cognitive performance and engagement in physi-
cal, social and intellectual activities in older adults:
The FIBRA study. Dementia & Neuropsychologia,
9, 270–278. http://dx.doi.org/10.1590/1980-
57642015dn93000010
Steibel, N. M., Olchik, M. R., Yassuda, M. S., Finger,
G., & Gomes, I. (2016). Influence of age and
education on the Rivermead Behavioral Memory
Test (RBMT) among healthy elderly. Dementia &
Neuropsychologia, 10, 26–30. http://dx.doi.org/10
.1590/s1980-57642016dn10100005
Sunderland, T., Hill, J. L., Mellow, A. M., Lawlor,
B. A., Gundersheimer, J., Newhouse, P. A., &
Grafman, J. H. (1989). Clock drawing in Alzhei-
mer’s disease. A novel measure of dementia sever-
ity. Journal of the American Geriatrics Society,
37, 725–729. http://dx.doi.org/10.1111/j.1532-
5415.1989.tb02233.x
Takada, L. T., Caramelli, P., Fichman, H. C., Porto,
C. S., Bahia, V. S., Anghinah, R., . . . Nitrini, R.
(2006). Comparison between two tests of delayed
recall for the diagnosis of dementia. Arquivos de
Neuro-Psiquiatria, 64, 35– 40. http://dx.doi.org/10
.1590/S0004-282X2006000100008
Tripathi, R., Kumar, K., Bharath, S., Marimuthu, P.,
& Varghese, M. (2014). Age, education and gen-
der effects on neuropsychological functions in
healthy Indian older adults. Dementia & Neuro-
psychologia, 8, 148–154. http://dx.doi.org/10
.1590/S1980-57642014DN82000010
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O.,
Huang, V., Adey, M., & Leirer, V. O. (1982).
Development and validation of a geriatric depres-
sion screening scale: A preliminary report. Journal
of Psychiatric Research, 17, 37– 49. http://dx.doi
.org/10.1016/0022-3956(82)90033-4
Received June 6, 2017
Revision received October 19, 2017
Accepted October 31, 2017 䡲