Psychometric validation of Fuld Object Memory Evaluation in older adults with cognitive impairments. Ho RTH(1)(2)(3), Fong TCT(1)(2), Hon. OBJECTIVES: Fuld Object Memory Evaluation (FOME) evaluates the episodic memory functions of encoding, storage, and recall across five recall trials and a. In this study the authors investigated the usefulness of the Fuld Object-Memory Evaluation (OME) as a culture-fair screen for dementia. Because the OME uses.
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Normative data of Fuld Object Memory Evaluation test for brazilian elderly population. This study aims to present normative data for Fuld Object Memory Evaluation test stratified by sex, gender, age, and education for the Brazilian elderly population. Statistical analyses were performed by independent t-test, one-way analysis of variance and multiple linear regression.
Statistical analyses showed that memory scores tend to improve significantly with increasing years of education and decrease significantly as age increased. We conclude that gender, education and age had effect on the Fuld Object Memory Evaluation performance in this Brazilian community-based sample. One of the most frequent and substantial complaints regarding cognition in the older population is related to changes in memory.
Deficits in memory tests, especially in episodic long-term memory, have the highest sensibility for the neuropsychological diagnosis of dementia 1 and amnestic mild cognitive impairment MCI. The greatest difficulties in assessing the memory of older subjects regarding the clinical diagnosis of dementia or MCI occur when the subjects evaluated are illiterate, have minimal formal education, or already have significant memory deficits.
A flexible and beneficial instrument to assess memory would provide a better ability to aid in the early diagnosis of dementia, especially if the instrument is not very long or difficult and has instructions that are easy to understand.
It has been incorporated in dementia research in different countries in populations with different durations of formal education as a measure of overall recall because it has simple instructions and seems easier to the patients because they touch and see the objects that must be memorised, and the objects are very simple and well known 45678.
In an interesting study, FOME was one of the 4 instruments used in a combination of cognitive tests and informant reports of dementia screening in low educated older people. This combination proved useful to improve the screening of mild to moderate dementia in low educated older people 9. The objective of the present study was to provide normative data on the FOME test for the Brazilian elderly population and to investigate the influence of education, age and sex on episodic memory performance.
Our hypothesis was that subjects who had less education would perform worse than those who had more years of education, younger subjects would perform better than older subjects, and sex would have no effect on performance. The normative sample consisted of 2, older subjects with normal cognitive performance selected as part of a two-phase epidemiological study to investigate the prevalence of dementia in a community-based sample in Sao Paulo and Ribeirao Preto, Brazil.
Data for this study were select between and Ribeirao Preto is a city in southeastern Brazil with a population of approximately , and A clustered random sampling of a population of individuals aged 60 years old and older from three different socioeconomic classes upper, middle and low was used, following official census data 11 This strategy aimed to evaluate a sample containing city districts that represent the area universe context of elderly individuals living in Sao Paulo and Ribeirao Preto.
Initially, the 96 city districts were ranked from the wealthiest to the poorest according to data from the Census, provided by IBGE. The following parameters were applied: Subsequently, the districts were divided into three groups, and a district that was representative of each socioeconomic stratum was chosen to represent the upper, middle and lower group.
In Sao Paulo, those three selected districts upper, middle and lower class had 17,; 17, and 14, elderly individuals, respectively.
Then, blocks of 10 homes were randomly chosen in each of the 90 selected census sectors. Following local media newspaper, radio, television and mail advertisement, a trained team started a systematic door-knocking survey, visiting 8, homes to find elderly subjects.
The interviewers tried at least three times to evaluate the elderly subjects at home before they were considered to have refused. The socio-demographic characteristics of the sample assessed at home have been presented in greater detail recently 13but the mean age was In Ribeirao Preto, a sample of 1, subjects were approached, of whom 1, agreed to participate subjects refused to participate; rate of attrition: The sample came from three socio-economic levels in the following fashion: The sample had a mean age of In the first phase of this study, subjects were screened for dementia with a combination of cognitive tests and functional scales: Depressive symptoms were evaluated with a item instrument, the D scores from 0 to 10which contains questions related to the presence of depressive symptoms most of the time during the past 2 weeks The following instruments were also used: All individuals with positive screenings for dementia and depression and a random sample of negative screenings were invited for the second phase, where clinical evaluation and diagnosis were achieved by the consensus of at least two physicians and consistency with the DSM-IV American Psychiatric Association, 19 criteria for psychiatric diagnosis.
All subjects considered negative after screenings in the community phase and all subjects evaluated in the second phase who were considered free of psychiatric diagnoses were considered for the present investigation.
This sample was then stratified for education, age and sex. Education was categorized into four groups: Age was divided into three groups: The investigation was approved by the local ethics committee, and all of the subjects agreed to participate in the study by signing the informed consent. The FOME is an instrument used to evaluate several components of learning and memory in elderly people, and it also provides information about tactile recognition, right-left discrimination, and verbal fluency.
Ten common objects in a bag ball, button, matchbox, pacifiers, spoon, toothbrush, pencil, comb, catch, cup are presented to the subjects to determine whether he can identify objects by touch, alternating systematically right and left hand.
The patient name each object and then pulls it out of the bag to see if he was right. After each recall, he is slowly and clearly reminded verbally of each item omitted in that trial, for a total of 5 trials. A sec rapid semantic retrieval trail comes after each learning trail as a distractor for the next recall trial. After a 15 minutes interval filled by other tests, an unexpected final recall is requested.
Then, a multiple choice recognition task is elicited only for those items not recalled. In the original version the ten objects in the bag are; ball, bottle, button, card, cup, key, matches, nail, ring, scissors, obmect were changed by the previously listed objects. The data collected during the test are classified as follows: Immediate retrieval is determined by the total sum of items remembered in all trials; the storage efficiency is determined by the number of different items recalled over the 5 trials and the retrieval efficiency is determined by the total number of items recalled in successive trails without any reminding.
Delayed recall is the number of items remembered spontaneously after an interval. The statistical analysis was based on the crude means and standard mdmory SD of the FOME scores and on the frequencies and percentages of socio-demographic variables. Normality of distribution evaluaton verified using the Kolmogorov-Smirnov test. The factors associated with memory score were analysed by multiple linear regression models with FOME score as dependent variable and education, age and sex as independent variables.
The initial multivariate model included all variables and its interactions. For descriptive purposes, years of education were divided into four groups, and age was divided into three age ranges.
Clinical validity of Fuld Object Memory Evaluation to screen for dementia in a Chinese society.
Bayer-Activities of Daily Living Scale. Table 2 shows the mean and standard deviation SD of the FOME scores, immediate total recall, delayed recall, recognition and verbal fluency scores between sex. In general, fu,d presented higher scores except in verbal fluency animal and sad, and recognition. Table 3 shows the mean and SD of the FOME scores, immediate total recall, delayed recall, recognition and verbal fluency scores in the three different age groups.
The FOME score decreased with advancing age with statistical significance except in recognition. Fuld Object Memory Evaluation. Table 4 shows mean and SD for evaluaiton FOME scores, immediate total recall, delayed recall, recognition and verbal fluency scores memofy the three different education levels.
Data show that FOME scores increased with increasing years of education with statistical significance.
The fuld object-memory evaluation: development and validation of an alternate form.
To identify the simultaneous effect of education, age and sex on the FOME scores, a multiple linear regression analysis was performed and is displayed in Table 6. Sex did not present significant interactions with sex and education. The reference groups of women objctyounger individuals age and participants with higher education levels education were considered to provide better clinical interpretation and all these three variables presented significant influence on the FOME score.
We analysed the performance of a Brazilian community-based sample of older subjects drawn from two Brazilian cities on the FOME test. The main finding of the fulld study is that the FOME test is influenced by education, age and sex.
Age and education are variables known to affect cognitive performance, so the influence of these two variables on the FOME score is not surprising. Generally, aging affects fluid intelligence, ruld episodic memory 23and the influence of education on cognition is already well documented in the literature Our results regarding memory are in accordance with previous findings from Brazilian studies, which also showed the influence of education and age on episodic memory tests.
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One study that assessed verbal episodic memory in a sample of older adults documented significant differences between literate and illiterate subjects Another study that assessed verbal and visual episodic memory in a sample of the Brazilian population found that age and years of education had a significant influence on the tests results.
However, no significant influence of sex was observed The same influence was documented in the normative data of the word list test with a health elderly sample, but again, no influence of sex was reported Brazilian data indicate that education has no influence on the FOME exit score, and these data might be explained by sample characteristics, such as smaller sizes and less heterogeneity regarding education attainment compared to the present community-based sample 28 Regarding the influence of sex on the episode memory test, this result was not expected based on results reported in the literature 26 Therefore, although the statistical analysis indicated that education influenced FOME scores, the FOME remains suitable for use in older people with lower levels of education.
Another reason supporting its use is that it is a memory test during which even very elderly patients with significant memory problems and individuals with very low formal education typically do not complain or show anxiety.
On the contrary, they enjoy the test. A different reaction is frequently observed for word list tests, in that patients sometimes refuse to perform them. Our results corroborate a previous study, which showed that the FOME was a good test for assessing older people with few years of schooling Another study in China found influences of age and education on the FOME performance but less influence of sex in the older population The normative data are relevant due to the limited availability of memory tests standardised for the Brazilian population; moreover, the data presented can help clinicians to better interpret immediate and delayed scores on episodic memory tests in older Brazilians with varying degrees of education from community-based or primary care samples.
Our results also support the notion that clinicians should carefully analyse the memory test performance in low-education elderly populations with memory complaints.
In conclusion, data presented here can help clinicians to better diagnosis Brazilian elderly with memory problems. There is a limitation of this study, some classifications that the FOME test can provide, storage and retrieval efficiency, could not be analysed in these study because on the time of the data evalyation, these classifications were not tabulated. Guaranteed stimulus-processing in the evaluation of the memory and learning. Object-memory evaluation for prospective detection of dementia in normal functioning elderly: J Clin Exp Neuropsychol.
Neuropsychological performance of Hispanic and non-Hispanic older adults: Am J Geriatr Psychiatry.
Neuropsychological assessment of psychogeriatric patients with limited education. Verbal learning and everyday functional in dementia: Neuropsychological prediction of dementia and the absence of dementia in rvaluation elderly persons.
Combined instruments for the screening of dementia in older people with low education. High prevalence of dementia in a community-based survey of older people from Brazil: Contagem populacional de Dement Geriatr Cogn Disord.