Read Writ (2012) 25:2275–2289 DOI 10.1007/s11145-012-9357-8
The influence of reading and writing habits associated with education on the neuropsychological performance of Brazilian adults Josiane Pawlowski • Eduardo Remor • Maria Alice de Mattos Pimenta Parente • Jerusa Fumagalli de Salles • Rochele Paz Fonseca Denise Ruschel Bandeira
•
Published online: 25 January 2012 Ó Springer Science+Business Media B.V. 2012
Abstract This study evaluated the influence of the frequency of reading and writing habits (RWH) associated with education on the performance of adults in brief neuropsychological tasks. A sample of 489 Brazilian subjects, composed of 71% women, aged 21–80 years, with 2–23 years of formal education, was evaluated by the Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN. This battery was developed to briefly examine orientation, attention, perception, memory, arithmetic abilities, language, praxis, and executive functions, in the context of Brazilian culture. Education was measured by years of study in teaching institutions, and the frequency of RWH was measured by a scale for specific reading and writing items. Six groups were composed by a combination of the variables education and frequency of RWH. One-way analysis of variance indicated significant differences between groups in the attention, memory, arithmetic abilities, language, The preparation of the manuscript was made possible in part by a grant for doctorate study received by the first author (CAPES-UFRGS No. 0667/09-9) to a doctoral internship in the Department of Biological Psychology and Health, Psychology Faculty, Universidad Auto´noma de Madrid (Spain), from May 2009 to April 2010, under the guidance of the second author. J. Pawlowski (&) Psychometry Department, Psychology Institute, Federal University of Rio de Janeiro, Av. Pasteur, 250, Pavilha˜o Nilton Campos, Praia Vermelha, Urca, Rio de Janeiro, Brazil e-mail:
[email protected] E. Remor Department of Biological Psychology and Health, Autonomous University of Madrid, Madrid, Spain M. A. de Mattos Pimenta Parente J. F. de Salles D. R. Bandeira Post-Graduate Program in Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil R. P. Fonseca Post-Graduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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constructional praxis, problem solving and verbal fluency tasks of NEUPSILIN. Results pointed to the relevance of the frequency of RWH to performance in attention, working memory, executive functions, and language tasks. Cognitive stimulation after the formal education period is essential for less educated individuals, and frequency of RWH may promote an improvement in cognitive development, as verified by neuropsychological tests. Keywords Cognitive development Educational degrees Neuropsychological assessment Reading Writing skills
Introduction The literature on neuropsychological assessment and normative studies of neuropsychological batteries or tests indicate that performance on cognitive tasks is highly correlated with age and education (Ardila, 2005; Kotik-Friedgut, 2006; Lezak, Howieson, & Loring, 2004; Ostrosky-Solı´s et al., 2007; Pen˜a-Casanova et al., 2009; Radanovic, Mansur, & Scaff, 2004; Strauss, Sherman, & Spreen, 2006). Advancing age is accompanied by decline in cognitive functions, especially attention and memory, as measured by neuropsychological tasks, while higher educational experience and formal learning opportunities are correlated with better performance on neuropsychological tasks (Glisky, 2007; Matallana et al., 2011; Welsh-Bohmer et al., 2009; Yassuda et al., 2009). The influence of education on performance on neuropsychological tasks can be identified even in brief cognitive assessments, for example, the mini-mental state examination (MMSE) and NEUROPSI (Hong et al., 2011; Matallana et al. 2011; Ostrosky-Solı´s et al., 2007). In a study of the performance of Brazilian subjects on the MMSE, Kochhann, Cerveira, Godinho, Camozzato, and Chaves (2009) indicated that young, highly educated individuals present better cognitive performance, and Laks et al. (2010) concluded that orientation, attention/calculation, repetition, reading, writing, and drawing scores improved as education increased. Despite the significant effects of education, it is important to consider that the quality of education varies widely in Brazil (Alves, 2008; Franco, Alves, & Bonamino, 2007). Studies in other countries have shown that differences in the quality of education, when measured by reading abilities and cultural experiences, contribute to differences in performance on cognitive tests (Dotson, Kitner-Triolo, Evans, & Zonderman, 2009; Manly, Byrd, Touradji, & Stern, 2004; Snitz et al., 2009). Individuals from less educated or ethnic minority populations often present differences in education and culture that result in differences in scores on neuropsychological tasks (Ardila et al., 2000; Byrd et al., 2005; Foss, Vale, & Speciali, 2005; Rosselli, Tappen, Williams, & Salvatierra, 2006; Unverzagt et al., 2007). Nevertheless, adults who are deprived of formal educational environments may be exposed to other stimuli that provide gains in cognitive performance. Learning opportunities at work or in an informal environment are associated with maintaining cognitive stimulation (for example, habits of reading and writing) and can
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contribute to the development of cognitive skills. Lachman, Agrigoroaei, Murphy, and Tun (2010) noted the importance of performing cognitive activities (e.g., reading, writing, word games, puzzles, lectures or educational courses) to improve cognitive function. The authors examined the episodic memory and executive functions of 3,343 men and women between 32 and 84 years of age and analyzed the relationship of these measures to years of education and frequency of cognitive activity. Lachman et al. (2010) concluded that people with less education have lower scores on episodic memory and executive functions, but that cognitive functioning can be improved by performing various cognitive activities, such as with compensatory benefits for episodic memory. Among the practices that contribute to cognitive development, reading and writing skills can also improve performance on neuropsychological tasks. Some studies have examined the relationship between reading and writing skills and cognitive abilities (Kellogg, 2008; Lachman et al., 2010; Uno, Wydell, Haruhara, Kaneko, & Shinya, 2009). Brama˜o et al. (2007) have shown that reading skills influence performance on visuomotor tasks. In the evaluation of a sample of 102 Brazilian subjects between 18 and 40 years of age, Pawlowski, Fonseca, Salles, Parente, and Bandeira (2008) found moderate correlations between the habits of reading and writing and performance on the memory, praxis, and problem solving tasks of the Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN (Fonseca et al., 2008, 2009). The variation in cognitive performance found in some studies may be due to differences in RWH among individuals. Considering the importance of cognitive stimulation to performance improvement in neuropsychological tasks, we aimed to investigate the relationship among three levels of education, combined with higher and lower frequencies of RWH, on the performance of adults and elderly subjects in the tasks of NEUPSILIN. This study hypothesizes that people who habitually read and write can usually produce higher scores on neuropsychological tasks. For highly educated individuals, the influence of RWH on cognitive abilities may be more evident in their performance on more complex neuropsychological tasks.
Method Participants The sample consisted of 489 adults from the southern region of Brazil, all of whom were native Brazilian Portuguese speakers, from 21 to 80 years of age (M = 49.73; SD = 18.55), with 2–23 years of formal education (M = 8.7; SD = 4.9). This sample was selected from a database of 1,017 participants who participated in the validation study of the NEUPSILIN (Fonseca et al., 2008, 2009). After excluding adolescent participants, who still were in the process of formal learning, the final sample (n = 489) was established. All participants included in the validation study were previously assessed by questionnaires and self-reported scales to check inclusion criteria. The 1,017 participants in the validation study showed no evidence of neurological or psychiatric disorders, no recent use of psychoactive drugs (illicit
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drugs and benzodiazepines), no alcohol or tobacco dependence, no signs of depression in either moderate or severe levels, and no signs of dementia, all of which are variables that could influence performance on cognitive tasks. Procedure for selection of participants The study was conducted in accordance with the ethical principles of human research and the project was approved by the Ethical Research Committee of the Federal University of Rio Grande do Sul (Brazil) under protocol number 2006530. The criteria and instruments for sample selection are described in detail in previous studies (Fonseca et al., 2009; Pawlowski et al., 2008). The sample of 489 adults was divided into six groups according to three levels of education (the lowest 25th percentile, the highest 25th percentile and the 25th to 75th percentile) and two levels of frequency of RWH (low and high, according to a score of 11 points—median—in the Scale of Reading and Writing Habits, as described in the Instruments section). Age, education, and sex characteristics of each group are presented in Table 1. Instruments The Scale of Reading and Writing Habits is included in the demographic survey of health and cultural conditions (Pawlowski, 2007). It evaluates the weekly frequency of reading magazines, newspapers, books and other materials, and the weekly frequency of writing text messages, letters and other materials. The frequency ratings are: daily (4 points); a few days a week (3 points); once a week (2 points); rarely (1 point), and never (0 point), with a maximum frequency score of 28 points. The Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN (Fonseca et al., 2008, 2009) briefly assesses components of temporal–spatial orientation, attention, perception, memory, arithmetic, language, praxis and executive functions (i.e., simple problem solving and verbal fluency). NEUPSILIN is divided into 32 tasks, which have been described in detail in previous studies (Fonseca et al., 2008, 2009; Pawlowski et al., 2008). Summarized information is presented in Table 2. Data analysis Data were analyzed with the SPSS program version 17.0 for Windows. One-way analysis of variance (ANOVA) with post hoc Bonferroni was performed to check for differences in age between groups and a t test for independent samples was applied to compare the means of men and women in each cognitive function. To demonstrate the differences between groups, the results of temporal–spatial orientation, attention, perception, memory, arithmetic, language, praxis and executive functions assessed by NEUPSILIN were transformed into z-scores for each group, and graphs were composed. ANOVA with post hoc Bonferroni was performed to evaluate the performance differences between groups in the tasks of NEUPSILIN.
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3.39 (0.75)
72/23
Education M (SD)
Sex women/men
36
22/14
3.51 (0.65)
46.44 (19.10)
120
83/37
7.42 (2.12)
49.97 (18.96) 79/27
8.10 (2.26)
50.25 (17.55)
106
: RWH
; RWH low reading and writing habits (B11 points) and : RWH high reading and writing habit ([11 points)
53.14 (16.67)
95
; RWH
; RWH
: RWH
5–11 years of education
0–4 years of education
Age M (SD)
N
Groups
Table 1 Description of the six groups of education/frequency of reading and writing habits (RWH)
21/9
15.13 (2.66)
59.20 (19.45)
30
; RWH
70/32
15.73 (2.46)
44.11 (18.74)
102
: RWH
12–23 years of education
The influence of reading and writing habits 2279
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2280 Table 2 Cognitive functions, components, tasks and scores in NEUPSILIN, adapted from Fonseca, Salles, and Parente (2008)
J. Pawlowski et al.
Cognitive functions 1. Orientation
Components and tasks
Scores
1.1 Time
0–4
1.2 Space
0–4
2. Attention (sustained)
2.1 Inverse counting
0–20
2.2 Digit sequence repetition
0–7
3. Perception (visual)
3.1 Verification of similarity and mismatch between lines
0–6
4. Memory
3.2 Visual hemineglect
0–1
3.3 Face perception
0–3
3.4 Face recognition
0–2
4.1 Working memory 4.1.1 Ascendent ordering of digits
0–10
4.1.2 Oral word span in sentences
0–14
4.2 Verbal episodic-semantic memory 4.2.1 Immediate recall
0–9
4.2.2 Delayed recall
0–9
4.2.3 Recognition
0–18
4.3 Long-term semantic memory
0–5
4.4 Short-term visual memory
0–3
4.5 Prospective memory
0–2
5. Arithmetic skills
5.1 Four calculations
0–8
6. Language
6.1 Oral language 6.1.1 Naming
0–4
6.1.2 Repetition
0–10
6.1.3 Automated language
0–2
6.1.4 Oral comprehension
0–3
6.1.5 Inferential processing
0–3
6.2 Written language 6.2.1 Reading aloud
7. Praxis
8. Executive functions
123
0–12
6.2.2 Written comprehension
0–3
6.2.3 Spontaneous writing
0–2
6.2.4 Copied writing
0–2
6.2.5 Dictated writing
0–12
7.1 Ideomotor
0–3
7.2 Constructional
0–16
7.3 Reflexive
0–3
8.1 Problem solving
0–2
8.2 Verbal fluency
0–7
The influence of reading and writing habits
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Results The six groups showed no statistically significant difference in mean age. There was also no statistically significant difference in the comparison of performance of men and women in each cognitive function assessed. Because of these results, sex and age were not inserted as control variables for the comparison of performance among the six groups on neuropsychological tasks. As shown in Fig. 1, there is a progression in performance skills as education and habits of reading and writing increase, and better performance on all of the tasks was found for groups with high-frequency RWH. This is especially true of the results for the cognitive abilities of attention, memory, arithmetic skills, language, praxis, and executive functions. The results of the ANOVA with post hoc Bonferroni comparing the means of groups in each task are presented in Table 3. Statistically significant differences were found between groups in performance of attention (i.e., inverse counting and digit sequence repetition tasks), memory (i.e., ascendant ordering of digits, oral word span in sentences, immediate recall, delayed recall, recognition, long-term semantic memory, short-term visual memory and prospective memory tasks), arithmetic abilities, language (with the exception of naming and automated language tasks), constructional praxis tasks and tests of executive functions (i.e., problem solving and verbal fluency tasks). We observed similar results between less educated subjects with a high frequency of RWH and highly educated subjects with a high frequency of RWH in attention tasks (inverse counting and digit sequence repetition) and language tasks (i.e., repetition, reading aloud, written comprehension and spontaneous writing). For arithmetic tasks, the less educated group with a higher frequency of RWH performed better than the less educated group with a lower frequency of RWH. In the oral word span in sentences task, a measure of WM, the group with the highest amount of education and the highest frequency of RWH performed best, with a statistically significant difference from the other groups. For verbal memory, including immediate recall, delayed recall and recognition tasks, a statistically significant difference was only found for the group with the highest level of education and the highest frequency of RWH when compared to groups with lower levels of education. It is important to mention that no statistically significant differences were found between any of the cognitive tasks evaluated in the comparison between the groups with an educational level from 5 to 11 years, regardless of the frequency of RWH.
Discussion This study demonstrated the importance of the association between education and frequency of RWH on the cognitive performance of adults as evaluated by NEUPSILIN. The results indicate the relevance of the frequency of RWH to successful performance of subjects on attention, memory, arithmetic abilities, language, constructional praxis, problem solving and verbal fluency tasks of NEUPSILIN.
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Fig. 1 z-scores in NEUPSILIN tasks by groups of education and reading and writing habits (RWH)
123
a
16.69 (6.5)a,b 2.64 (1.74)a,b
a
3.89 (0.31)
15.33 (6.74)a
2.02 (1.41)a
Space orientation
Inverse counting
Digit sequence repetition
6.31 (1.86)b 3.97 (0.17)a 9.61 (0.60)a,b 1.86 (0.35)a a
1.26 (0.81)a
4.43 (2.67)a
3.99 (0.10)a
9.58 (0.81)a
1.88 (0.32)a
a
Prospective memory
Arithmetic
Naming
Repetition
Automated language 2.08 (0.77)a,b
2.67 (0.63)
1.39 (0.80)a,b
2.60 (0.61)a,b
Short-term visual memory
2.06 (0.78)a
2.44 (0.81)a
4.25 (0.85)a
Long-term semantic memory
2.71 (0.54)
4.47 (0.77)a,b
11.65 (2.22)a
Recognition
Oral comprehension
11.81 (2.46)a
1.33 (1.64)a
Delayed recall
Inferential processing
1.67 (1.69)a
4.07 (1.49)
Immediate recall 4.22 (1.10)
a
10.11 (5.54)a,b
a
9.51 (5.38)a
Oral word span in sentences
a
a
Face recognition 4.97 (2.17)
1.75 (0.44)a
1.80 (0.40)a
Face perception
4.32 (2.43)
2.25 (0.81)a
2.17(0.82)a
Visual hemineglect
Ascendant ordering of digits
1.00 (0.00)a
5.16 (1.11)
1.00 (0.00)a
Verification of lines 5.33 (0.93)
a
a
3.92 (0.37)
3.69 (0.52)a
3.76 (0.56)a
Time orientation
2.35 (0.68)a,b,c
2.86 (0.37)
a,b
1.97 (0.18)a
9.73 (0.59)a,b
4.00 (0.00)a
7.13 (1.50)b,c
1.40 (0.80)a,b
2.65 (0.60)a,b
4.67 (0.61)b,c
11.92 (2.35)a
1.72 (1.71)a
4.43 (1.34)
a
13.07 (4.37)b,c
6.55 (1.98)
b
1.83 (0.42)a
2.36 (0.72)a
1.00 (0.00)a
5.28 (1.01)
a
3.10 (1.92)b
18.32 (4.38)b
3.99 (0.09)
a
3.79 (0.45)a
; RWH M (SD)
: RWH M (SD)
; RWH M (SD)
Tasks of NEUPSILIN
a
2.61 (0.49)c,d
2.89 (0.37)
a,b
1.95 (0.21)a
9.88 (0.33)b
4.00 (0.00)a
6.94 (1.48)b,c
1.48 (0.75)a,b
2.79 (0.45)a,b
4.89 (0.37)b,c
12.36 (2.33)a
2.17 (1.86)a
4.72 (1.38)
14.43 (4.9)c
6.85 (1.93)
b
1.92 (0.26)a
2.46 (0.66)a
1.00 (0.00)a
5.33 (1.04)
a
3.26 (1.95)b
18.99 (3.14)b
3.97 (0.22)
a
3.87 (0.34)a
: RWH M (SD)
5–11 years of education
0–4 years of education
Groups
Table 3 One-way analysis of variance and differences between groups in the tasks of NEUPSILIN
2.60 (0.62)b,c,d
2.93 (0.25)
a,b
1.97 (0.18)a
9.90 (0.30)a,b
4.00 (0.00)a
7.27 (0.98)b,c
1.57 (0.73)a,b
2.67 (0.61)a,b
4.80 (0.41)b,c
12.67 (2.45)a,b
2.20 (1.99)a,b
4.80 (1.32)
a,b
13.90 (4.83)b,c
7.37 (1.47)
b,c
1.93 (0.25)a
2.53 (0.78)a
1.00 (0.00)a
5.27 (1.08)
a
3.17 (1.84)a,b
19.17 (3.30)b
4.00 (0.00)
a
3.73 (0.52)a
; RWH M (SD)
2.78 (0.44)d
2.98 (0.14)
b
1.99 (0.10)a
9.91 (0.32)b
4.00 (0.00)a
7.80 (0.58)c
1.75 (0.50)b
2.89 (0.37)b
4.96 (0.19)c
14.05 (2.19)b
3.52 (2.34)b
5.61 (1.59)b
19.08 (5.48)d
7.97 (1.65)c
1.96 (0.19)a
2.41 (0.71)a
1.00 (0.00)a
5.62 (0.76)
a
3.93 (2.01)b
19.71 (2.01)b
4.00 (0.00)a
3.94 (0.27)a
: RWH M (SD)
12–23 years of education
3.97
3.20
17.90*
6.66*
3.49
5.80*
1.48
46.94*
4.99*
5.44*
19.64*
14.06*
15.97*
13.77*
40.71*
39.84*
4.19
2.29
–
2.37
11.29*
11.73*
F
The influence of reading and writing habits 2283
123
123 2.97 (0.17)a 10.67 (2.22)a,b 2.28 (0.88)a a
2.93 (0.26)a
8.99 (2.62)a
1.99 (1.09)a
a
Ideomotor praxis
Constructional praxis
Reflexive praxis 2.56 (1.18)a,b
1.44 (0.50) 2.69 (0.92)a,b
1.62 (0.52)
a,b
2.09 (1.03)a
11.38 (2.50)b
2.97 (0.18)a
10.38 (1.43)b
1.80 (0.40)b,c
1.67 (0.58)
b
2.84 (0.43)a,b
3.10 (0.96)b
1.66 (0.51)
a,b
2.17 (1.01)a
11.42 (2.47)b
3.00 (0.00)a
10.75 (1.10)b,c
1.92 (0.28)c
1.72 (0.51)
b
2.81 (0.42)a,b
11.78 (0.48)b
3.17 (0.99)b,c
1.70 (0.47)
a,b
2.13 (1.01)a
12.27 (1.72)b,c
2.97 (0.18)a
11.27 (0.83)b,c
1.87 (0.43)b,c
1.83 (0.46)
b
3.00 (0.00)a,b
11.83 (0.38)b
; RWH M (SD)
3.63 (0.94)c
1.87 (0.33)b
2.42 (0.93)a
13.69 (1.86)c
3.00 (0.00)a
11.41 (0.76)c
2.00 (0.00)c
1.93 (0.29)
b
2.91 (0.32)b
11.93 (0.25)b
: RWH M (SD)
12–23 years of education
26.56*
9.81*
2.13
41.23*
2.87
42.19*
21.28*
21.21*
5.67*
25.45*
F
* p \ .001. To each line. Different letters (a, b, c, d) mean statistically significant difference (p B .001) between groups in the post hoc Bonferroni analyses; ; RWH less reading and writing habits (B11 points) and : RWH high reading and writing habit ([11 points)
2.19 (0.82)a
9.97 (1.36)b
8.36 (2.76)a
Dictated writing
Verbal fluency
1.61 (0.49)a,b
1.15 (0.78)
1.47 (0.62)a
Spontaneous writing
Copied writing
1.40 (0.63)
a,b
a
Problems solving
2.69 (0.58)a,b
2.63 (0.62)a
Written comprehension 1.50 (0.65)
11.06 (1.01)a,b
10.29 (2.38)a
Reading aloud
11.60 (0.70)b
; RWH M (SD)
: RWH M (SD)
; RWH M (SD)
Tasks of NEUPSILIN
: RWH M (SD)
5–11 years of education
0–4 years of education
Groups
Table 3 continued
2284 J. Pawlowski et al.
The influence of reading and writing habits
2285
An important result in attention tasks (inverse counting and digit sequence repetition) for the less educated group with a higher frequency of RWH was found in this study. Commodari and Guarnera (2005) pointed to a relationship between reading ability and attention skills, as measured by digit span, in a sample of 98 students in their first and second years of school. The digit span task measures particularly sustained or controlled attention. In the reading process, it is necessary to maintain controlled attention and to inhibit irrelevant information to absorb and understand what is being read (Seigneuric & Ehrlich, 2005; Swanson & Jerman, 2007). Related to this result, the frequency of writing and reading habits was relevant to the performance of the sample of people with less education in verbal fluency, a task of NEUPSILIN that evaluate an executive function component, and to the performance of the highest educated group in oral word span in sentences, a more complex WM task of NEUPSILIN. Tasks involving attention, executive functions and WM have in common the employment of information storage and processing skills, including the inhibition of automatic behaviors, which is essential to the reading process. Controlled attention and inhibition are components of working memory (WM) and executive functions. Some studies have examined the relationship between writing and reading processes and the components of WM. For Vanderberg and Swanson (2007), the component of supervised attention of WM is most related to the writing process and the central executive component of WM significantly predicts the planning, writing, revision, grammar, and punctuation measures. According to Schneider and Dixon (2009), reading is a complex cognitive activity that involves constructing and maintaining coherent mental representations in WM. The influence of RWH associated with education was also observed in arithmetic ability. Reading and arithmetic involve very similar cognitive demands, including WM, executive function and storage (Lundberg & Sterner, 2006). In the language tasks of NEUPSILIN, frequency of reading and writing affected performance of repetition, reading aloud, written comprehension and spontaneous writing tasks. This result is expected, because these simple NEUPSILIN tasks also take place in more complex reading and writing activities. Reading exercises can also contribute to better performance in semantic memory and verbal fluency skills, because they increase general knowledge and, consequently, expand the vocabulary, the registry of different information, and the recall of learned content that contribute to the enhancement of semantic memory. For Gagne´, Yekovich, and Yekovich (1993), the act of reading consists of the following cognitive processes: (1) decoding, which presupposes the activation of word meaning in semantic memory, both by the visual activation of the printed word and by the grapheme–phoneme (letter–sound); (2) literal comprehension, which involves the activation of word meaning in sentence format; (3) inferential comprehension of the idea subjacent to the phrase; and (4) comprehension monitoring, that is, reading goal definition, which refers to one’s verification and implementation of strategies to achieve a goal. For verbal memory, those with a greater frequency of RWH showed better performance on three tasks of verbal episodic memory, which reinforces the findings of Lachman et al. (2010).
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The importance of the frequency of RWH, combined with education, was also observed in the performance of adults in the constructional praxis tasks of NEUPSILIN. Hong et al. (2011) demonstrated that scores on the ADAS-cog constructional praxis test were higher in an educated/literate group compared with an uneducated/illiterate group, which presented the lowest scores in the constructional praxis test. Seo et al. (2007) also found an effect of education greater than the impact of age on the performance of older people on the Benton Visual Retention Test, which assesses constructional ability, visual perception and memory. Praxis is the ability to plan and execute new motor movements, and the practice of handwriting (i.e., the ability to demonstrate appropriate letter formations and sequences by arranging letters in appropriate order to form words) has an effect on constructional praxis tasks. Better results are expected in constructional praxis tasks in the presence of a higher frequency of writing habits. These results suggest that the regular practice of reading and writing can compensate for low education in the performance of cognitive tasks. When high education or a high frequency of RWH were present, a better performance was achieved in tasks of NEUPSILIN that involved attention, WM, executive functions, and language. WM is important to reading and handwriting (Peverly, 2006). Cognitive control measures like inhibition, attention, and memory are expected to have an effect on early literacy skills (Kegel, van der Kooy-Hofland, & Bus, 2009). Executive functions contribute to the writing development of elementary-level students and play a role in developing reading–writing connections (Altemeier, Jones, Abbott, & Berninger, 2006). Even without a high level of education, a person who includes reading and writing in his or her weekly activities can improve his or her performance on some cognitive tasks. The results also suggest that, for highly educated individuals, the influence of RWH on cognitive abilities was evident in their performance on more complex neuropsychological tasks. The lack of difference between the groups with an intermediate educational level may be related to a greater homogeneity in relation to other characteristics such as age, financial income and cultural access, variables that must be considered and evaluated further in future studies. The similarity of performance in some tasks between the less educated group with a high frequency of RWH and the highly educated group with a low frequency of RWH may be linked to differences in quality of education. In countries like Brazil, the measure of formal study by time in years does not always reflect the quality of education. Therefore, in a neuropsychological evaluation, it is important to apply some measure of reading ability to estimate individual differences in education quality. For less educated people, a functional literacy test can be used for adults (Carthery-Goulart et al., 2009). The differences between groups can also be explained by financial income and cultural access. To improve this study, it is recommended that other factors be taken into consideration for the evaluation of effects on cognition (e.g., level of intelligence, financial income and cultural access). Regarding the number of participants in each group in this study, it is expected that those people who frequently read and write often belong to the group with the highest level of education. Similarly, it is expected that those people who read and write less frequently are most often those with less education. This explains the smaller number of people in the samples of
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this study for the groups mentioned above. Moreover, the sample of people with less education and higher frequency of RWH could be increased, as well as the sample with high education and low frequency of these habits. The analysis of extreme groups in relation to educational level could also be emphasized, as the groups with an intermediate level of education and a range of frequencies of reading and writing tended to present similar results among the various cognitive tasks evaluated here. The results of this study could be reviewed in a larger sample size for these groups to check for possible changes. Despite this limitation, this study showed the importance of considering more than education or number of years of study when conducting a neuropsychological evaluation. Therefore, further evaluation, by measuring the frequency of RWH, may contribute to understanding performance on neuropsychological tasks. The results of this study highlight the importance of social programs that encourage the practice of reading and writing as a habit in Brazil, as well as the practice of other cognitive activities for the improvement of cognitive abilities. The recommendation to practice reading and writing can also be adopted as an intervention in processes of neuropsychological rehabilitation.
References Altemeier, L., Jones, J., Abbott, R. D., & Berninger, V. W. (2006). Executive functions in becoming writing readers and reading writers: Note taking and report writing in third and fifth graders. Developmental Neuropsycholology, 29(1), 161–173. Alves, F. (2008). Polı´ticas educacionais e desempenho escolar nas capitais brasileiras [Educational policies and school performance in the brazilian capitals of states]. Cadernos de Pesquisa, 38(134), 413–440. Ardila, A. (2005). Cultural values underlying psychometric cognitive testing. Neuropsychology Review, 15(4), 185–195. Ardila, A., Ostrosky-Solı´s, F., Rosselli, M., & Gomez, C. (2000). Age related cognitive decline during normal aging: The complex effect of education. Archives of Clinical Neuropsychology, 15(6), 495–513. Brama˜o, I., Mendonc¸a, A., Faı´sca, L., Ingvar, M., Petersson, K. M., & Reis, A. (2007). The impact of reading and writing skills on a visuo-motor integration task: A comparison between illiterate and literate subjects. Journal of the International Neuropsychological Society, 13(2), 359–364. Byrd, D. A., Sanchez, D., & Manly, J. J. (2005). Neuropsychological test performance among Caribbeanborn and US-born African American elderly: The role of age, education and reading level. Journal of Clinical & Experimental Neuropsychology: Official Journal of the International Neuropsychological Society, 27, 1056–1069. Carthery-Goulart, M. T., Anghinah, R., Areza-Fegyveres, R., Bahia, V. S., Brucki, S. M. D., Damin, A., et al. (2009). Performance of a Brazilian population on the test of functional health literacy in adults. Revista de Sau´de Pu´blica, 43(4), 631–638. Commodari, E., & Guarnera, M. (2005). Attention and reading skills. Perceptual and Motor Skills, 100(2), 375–386. Dotson, V. M., Kitner-Triolo, M. H., Evans, M. K., & Zonderman, A. B. (2009). Effects of race and socioeconomic status on the relative influence of education and literacy on cognitive functioning. Journal of the International Neuropsychological Society, 15(4), 580–589. Fonseca, R. P., Salles, J. F., & Parente, M. A. M. P. (2008). Development and content validity of the Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN. Psychology & Neuroscience, 1(1), 55–62.
123
2288
J. Pawlowski et al.
Fonseca, R. P., Salles, J. F., & Parente, M. A. M. P. (2009). Instrumento de Avaliac¸a˜o Neuropsicolo´gica Breve NEUPSILIN [Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN]. Sa˜o Paulo: Vetor Editora. Foss, M. P., Vale, F. A. C., & Speciali, J. G. (2005). Influeˆncia da escolaridade na avaliac¸a˜o neuropsicolo´gica de idosos: Aplicac¸a˜o e ana´lise dos resultados da escala de Mattis para avaliac¸a˜o de demeˆncia (Mattis Dementia Rating Scale—MDRS) [Influence of education on the neuropsychological assessment of the elderly: Application and analysis of the results from the Mattis Dementia Rating Scale (MDRS)]. Arquivos de Neuropsiquiatria, 63(1), 119–126. Franco, C., Alves, F., & Bonamino, A. (2007). Qualidade do ensino fundamental: Polı´ticas, suas possibilidades, seus limites [Quality of education in Brazil: Policies, potentialities and limits]. Educac¸a˜o & Sociedade, 28(100), 989–1014. Gagne´, E. D., Yekovich, C. W., & Yekovich, F. R. (1993). The cognitive psychology of school learning. New York: Harper Collins. Glisky, E. L. (2007). Changes in cognitive function in human aging. In D. R. Riddle (Ed.), Brain Aging: Models, Methods, and Mechanisms. Boca Raton: CRC Press. Hong, Y. J., Yoon, B., Shim, Y. S., Cho, A. H., Lee, E. S., Kim, Y. I., et al. (2011). Effect of literacy and education on the visuoconstructional ability of non-demented elderly Individuals. Journal of International Neropsychological Society, 17(5), 934–939. Kegel, C. A. T., van der Kooy-Hofland, V. A. C., & Bus, A. G. (2009). Improving early phoneme skills with a computer program: Differential effects of regulatory skills. Learning and Individual Differences, 19, 549–554. Kellogg, R. T. (2008). Training writing skills: A cognitive developmental perspective. Journal of writing research, 1(1), 1–26. Kochhann, R., Cerveira, M. O., Godinho, C., Camozzato, A., & Chaves, M. L. (2009). Evaluation of Mini-Mental State Examination scores according to different age and education strata, and sex, in a large Brazilian healthy sample. Dementia & Neuropsychologia, 3(2), 88–93. Kotik-Friedgut, B. (2006). Development of the Lurian approach: A cultural neurolinguistic perspective. Neuropsychology Review, 16(1), 43–52. Lachman, M. E., Agrigoroaei, S., Murphy, C. M. A., & Tun, P. A. (2010). Frequent cognitive activity compensates for education differences in episodic memory. American Journal of Geriatric Psychiatry, 18(1), 04–10. Laks, J., Coutinho, E. S., Junger, W., Silveira, H., Mouta, R., Baptista, E. M., et al. (2010). Education does not equally influence all the Mini Mental State Examination subscales and items: Inferences from a Brazilian community sample. Revista Brasileira de Psiquiatria, 32(3), 223–230. Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment. New York: Oxford University Press. Lundberg, I., & Sterner, G. (2006). Reading, arithmetic, and task orientation: How are they related? Annals of Dyslexia, 56(2), 361–377. Manly, J. J., Byrd, D. A., Touradji, P., & Stern, Y. (2004). Acculturation, reading level, and neuropsychological test performance among African American elders. Applied Neuropsychology, 11, 37–46. Matallana, D., de Santacruz, C., Cano, C., Reyes, P., Samper-Ternent, R., Markides, K. S., et al. (2011). The relationship between education level and Mini-Mental State Examination domains among older Mexican Americans. Journal of Geriatric Psychiatry and Neurology, 24(1), 9–18. Ostrosky-Solı´s, F., Go´mez-Pe´rez, E., Matute, E., Rosselli, M., Ardila, A., & Pineda, D. (2007). NEUROPSI Attention and Memory: A neuropsychological test battery in Spanish with norms by age and educational level. Applied Neuropsychology, 14(3), 156–170. Pawlowski, J. (2007). Evideˆncias de validade e fidedignidade do Instrumento de Avaliac¸a˜o Neuropsicolo´gica Breve NEUPSILIN [Validity and reliability evidences of NEUPSILIN Brief Neuropsychological Assessment Instrument]. Unpublished masther’s thesis. Porto Alegre: PostGraduation Program in Psychology, Federal University of Rio Grande do Sul. Pawlowski, J., Fonseca, R. P., Salles, J. F., Parente, M. A. M. P., & Bandeira, D. R. (2008). Evideˆncias de validade do Instrumento de Avaliac¸a˜o Neuropsicolo´gica Breve NEUPSILIN [Validity evidences of NEUPSILIN Brief Neuropsychological Assessment Instrument]. Arquivos Brasileiros de Psicologia, 60(2), 101–116. Pen˜a-Casanova, J., Blesa, R., Aguilar, M., Gramunt-Fombuena, N., Go´mez-Anso´n, B., Oliva, R., et al. (2009). Spanish Multicenter Normative Studies (NEURONORMA Project): Methods and sample characteristics. Archives of Clinical Neuropsychology, 24, 307–319.
123
The influence of reading and writing habits
2289
Peverly, S. T. (2006). The importance of handwriting speed in adult writing. Developmental Neuropsychology, 29(1), 197–216. Radanovic, M., Mansur, L. L., & Scaff, M. (2004). Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: Influence of schooling. Brazilian Journal of Medical Biological Research, 37(11), 1731–1738. Rosselli, M., Tappen, R., Williams, C., & Salvatierra, J. (2006). The relation of education and gender on the attention items of the Mini-Mental State Examination in Spanish speaking Hispanic elders. Archives of Clinical Neuropsychology, 21, 677–686. Schneider, D. W., & Dixon, P. (2009). Visuospatial cues for reinstating mental models in working memory during interrupted reading. Canadian Journal of Experimental Psychology/Revue Canadienne de Psychologie Expe´rimentale, 63(3), 161–172. Seigneuric, A., & Ehrlich, M. (2005). Contribution of working memory capacity to children’s reading comprehension: A longitudinal investigation. Reading and Writing: An Interdisciplinary Journal, 18, 617–656. Seo, E. H., Lee, D. Y., Choo, I. H., Youn, J. C., Kim, K. W., Jhoo, J. H., et al. (2007). Performance on the Benton Visual Retention Test in an educationally diverse elderly population. Journal of Gerontology: Psychological Sciences, 62(3), 191–193. Snitz, B. E., Unverzagt, F. W., Chang, C. H., Bilt, J. V., Gao, S., Saxton, J., et al. (2009). Effects of age, gender, education and race on two tests of language ability in community-based older adults. International Psychogeriatrics, 21(6), 1051–1062. Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms and commentary. New York: Oxford University Press. Swanson, H. L., & Jerman, O. (2007). The influence of working memory on reading growth in subgroups of children with reading disabilities. Journal of Experimental Child Psychology, 96, 249–283. Uno, A., Wydell, T. N., Haruhara, N., Kaneko, M., & Shinya, N. (2009). Relationship between reading/ writing skills and cognitive abilities among Japanese primary-school children: normal readers versus poor readers (dyslexics). Reading and Writing: An Interdisciplinary Journal, 22(7), 755–789. Unverzagt, F. W., Gao, S., Lane, K. A., Callahan, C., Ogunniyi, A., Baiyewu, O., et al. (2007). Mild cognitive dysfunction: An epidemiological perspective with an emphasis on African Americans. Journal of Geriatric Psychiatry and Neurology, 20, 215–226. Vanderberg, R., & Swanson, H. L. (2007). Which components of working memory are important in the writing process? Reading and Writing: An Interdisciplinary Journal, 20(7), 721–752. Welsh-Bohmer, K. A., Ostbye, T., Sanders, L., Pieper, C. F., Hayden, K. M., Tschanz, J. T., et al. (2009). Neuropsychological performance in advanced age: influences of demographic factors and apolipoprotein E: Findings from the Cache County Memory Study. The Clinical Neuropsychologist, 23(1), 77–99. Yassuda, M. S., Diniz, B. S., Flaks, M. K., Viola, L. F., Pereira, F. S., Nunes, P. V., et al. (2009). Neuropsychological profile of Brazilian older adults with heterogeneous educational backgrounds. Archives of Clinical Neuropsychology, 24(1), 71–79.
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