Abstract
ABSTRACT.Judgment is the ability to make sound decisions after consideration of relevant information, possible solutions, likely outcomes, and contextual factors. Loss of judgment is common in patients with mild cognitive impairment (MCI) and dementia. The Test of Practical Judgment (TOP-J) evaluates practical judgment in adults and the elderly, with 15- and 9-item versions that require individuals to listen to scenarios about everyday problems and report their solutions.Objective: Adaptation of TOP-J for a Brazilian sample, preparation of a reduced version and verification of the accuracy of both.Methods: Eighty-five older adults, including 26 with MCI, 20 with Alzheimer’s disease (AD), 15 with frontotemporal dementia behavioral variant (FTDbv) and 24 controls, underwent neuropsychological assessment including the Brazilian adaptation of the TOP-J (TOP-J-Br).Results: On both TOP-J-Br versions, controls outperformed MCI, AD and FTDbv patients (p<0.001) and MCI outperformed AD and FTDbv (p<0.001). For the TOP-J/15-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 91.7%, specificity of 59.0% and area under the curve of 0.8. For the TOP-J/9-Br, the best cutoff for distinguishing controls and patients had a sensitivity of 79.9%, specificity of 72.1% and area under the curve of 0.82.Conclusion: The TOP-J/15-Br, and particularly the TOP-J/9-Br, showed robust psychometric properties and the potential for clinical utility in Brazilian older adults at various stages of neurodegenerative cognitive decline.
Highlights
JudgmentJudgment can be defined as the ability to make sound decisions after careful consideration of available information, contextual factors, possible solutions and likely outcomes.[1,2] Conceptually, practical judgment is closely related to both problem-solving and decision-making, and while these terms are often used interchangeably in the literature, there are subtle differences
The mild cognitive impairment (MCI) group and Alzheimer’s disease (AD) group were older than individuals in the control group and frontotemporal dementia behavioral variant (FTDbv) group
Validity based on internal structure Prior to performing the factor analysis Test of Practical Judgment (TOP-J)/15-Br, we performed two tests to determine whether components would result from the analysis
Summary
JudgmentJudgment can be defined as the ability to make sound decisions after careful consideration of available information, contextual factors, possible solutions and likely outcomes.[1,2] Conceptually, practical judgment is closely related to both problem-solving and decision-making, and while these terms are often used interchangeably in the literature, there are subtle differences. Judgment relies upon many cognitive processes including memory (remembering relevant past experiences), language (understanding verbal and nonverbal aspects, and communicating the decision to the people involved), sustained attention, reasoning.[5,6] and especially executive functions.[7,8] Emotional and social processes can impact judgment including one’s level of empathy, sensitivity to social feedback, perception of the consequences of the actions chosen for others, sense of responsibility, and social obligations It is important, not to confuse practical judgment with moral judgment, defined as evaluative judgment of the adequacy of behavior in the context of social perceptions of right and wrong.[9]
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