Brief assessment of executive impairment in elderly with stroke: Validation of Frontal Assessment Battery
DOI:
https://doi.org/10.7342/ismt.rpics.2016.2.2.39Keywords:
Stroke, Executive dysfunction, FAB, Elderly, ValidationAbstract
Background and Goals: Stroke potentiates the development of executive dysfunction, leading to impairment in the performance of daily activities. The neuropsychological assessment of executive functions is important to develop adequate rehabilitation strategies. Thus, describing the normative data, diagnostic accuracy, psychometric properties and factor analysis of the Frontal Assessment Battery (FAB), a brief and easy to administer instrument, in a clinical sample with stroke are objectives of this study. Method: Being part of the Aging Trajectories of Institutionalized Elderly, this research has a sample of 112 elderly people with a medical diagnosis of stroke and a control subgroup of 157 elderly people. The subjects have ages between 60 and 100 years old (M = 78.20, SD = 7.57), mostly females (n = 194). The measurements used include interviews and neuropsychological tests grouped in executive functioning measures, cognitive measures of reference, and clinical measures of control. Results: The variables age and education affect the scores obtained in the clinical subgroup, having the variable gender no impact on these. Using a cutoff score of 7, the FAB had a sensitivity of 83.4% and a specificity of 66.1% for screening stroke (AUC = 0.64); showed a Cronbach's α of 0.79, and strong correlations with executive tests (Stroop test, Rey Complex Figure, Attentional-Executive factor of Montreal Cognitive Assessment and Switching in the verbal fluency tests). The confirmatory factor analysis supported a one-factor structure. Conclusions: The FAB presents good internal consistency, convergent, and construct when used for the elderly with stroke. Due to some limitations of the study, which may explain the weak discriminant validity, further investigations are encouraged because FAB has shown promising psychometric properties.
Downloads
References
Alexander, G. E., DeLong, M. R., & Strick, P. L. (1986). Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience, 9(1), 357-381. [Google Scholar] [CrossRef]
Almeida, L. S., Lemos, G. C., & Lynn, R. (2011). Regional differences in intelligence and per capita incomes in Portugal. Mankind Quarterly, 52(2), 213-221. [Google Scholar] [URL]
Alvarenga, P. P., Pereira, D. S., & Anjos, D. (2010). Mobilidade funcional e função executiva em idosos diabéticos e não diabéticos [Functional mobility and executive function in elderly diabetics and non-diabetics] . Revista Brasileira de Fisioterapia, 14(6), 491-496. [Google Scholar] [CrossRef]
Amorim, P. (2000). Mini International Neuropsychiatric Interview (MINI): Validação de entrevista breve para diagnóstico de transtornos mentais [Mini International Neuropsychiatric Interview (MINI): Validation of a short structured diagnostic psychiatric interview] . Revista Brasileira de Psiquiatria, 22(3), 106-115. [Google Scholar] [CrossRef]
Anderson, P. (2002). Assessment and development of executive function (EF) during childhood. Child Neuropsychology, 8(2), 71-82. [Google Scholar] [CrossRef]
Appollonio, I., Leone, M., Isella, V., Piamarta, F., Consoli, T., Villa, M. L., . . . Nichelli, P. (2005). The Frontal Assessment Battery (FAB): Normative values in an Italian population sample. Neurological Sciences, 26(2), 108-116. [Google Scholar] [CrossRef]
Arbuckle, J. L. (2014a). Amos (Version 24.0) [Computer software] . Chicago: IBM SPSS. [Google Scholar] [URL]
Arbuckle, J. L. (2014b). Amos 24.0 user’s guide. Chicago: IBM SPSS. [Google Scholar]
Barbosa, I. G., Rocha, N. P., Huguet, R. B., Ferreira, R. A., Salgado, J. V., Carvalho, L. A., . . . Teixeira, A. L. (2012). Executive dysfunction in euthymic bipolar disorder patients and its association with plasma biomarkers. Journal of Affective Disorders, 137(1), 151-155. [Google Scholar] [CrossRef]
Basile, A. G., & Toplak, M. E. (2015). Four converging measures of temporal discounting and their relationships with intelligence, executive functions, thinking dispositions, and behavioral outcomes. Frontiers in Psychology, 6(728), 1-13. [Google Scholar] [CrossRef]
Beato, R., Amaral-Carvalho, V., Guimarães, H. C., Tumas, V., Souza, C. P., Oliveira, G. N., & Caramelli, P. (2012). Frontal Assessment Battery in a Brazilian sample of healthy controls: Normative data. Arquivos de Neuro-Psiquiatria, 70(4), 278-280. [Google Scholar] [CrossRef]
Beaumont, J. G. (2008). Introduction to neuropsychology (2nd ed.). New York: The Guilford Press. [Google Scholar]
Benke, T., Karner, E., & Delazer, M. (2013). FAB-D: German version of the Frontal Assessment Battery. Journal of Neurology, 260(8), 2066-2072. [Google Scholar] [CrossRef]
Benton, A. L. (1994). Neuropsychological assessment. Annual Review of Psychology, 45, 1-23. [Google Scholar] [CrossRef]
Boban, M., Malojčić, B., Mimica, N., Vuković, S., & Zrilić, I. (2012). The Frontal Assessment Battery in the differential diagnosis of dementia. Journal of Geriatric Psychiatry and Neurology, 25(4), 201-207. [Google Scholar] [CrossRef]
Bonett, D. G. (2002). Sample size requirements for testing and estimating coefficient alpha. Journal of Educational and Behavioral Statistics, 27(4), 335-340. [Google Scholar] [CrossRef]
Borkowski, J. G., Benton, A. L., & Spreen, O. (1967). Word fluency and brain damage. Neuropsychologia, 5(2), 135-140. [Google Scholar] [CrossRef]
Buchner, A., Erdfelder, E., Faul, F., & Lang, A. G. (2014). G*Power 3 (Version 3.1.9.2 for Macintosh) (Computer software). Düsseldorf: Heinrich-Heine-Universität Dusseldorf. [Google Scholar] [URL]
Bugalho, P., & Vale, J. (2011). Brief cognitive assessment in the early stages of Parkinson disease. Cognitive and Behavioral Neurology, 24(4), 169-173. [Google Scholar] [CrossRef]
Caffarra, P., Vezzadini, G., Dieci, F., Zonato, F., & Venneri, A. (2002). Rey-Osterrieth Complex Figure: Normative values in an Italian population sample. Neurological Sciences, 22(6), 443-447. [Google Scholar] [CrossRef]
Castiglioni, S., Pelati, O., Zuffi, M., Somalvico, F., Marino, L., Tentorio, T., & Franceschi, M. (2006). The Frontal Assessment Battery does not differentiate frontotemporal dementia from Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 22(2), 125-131. [Google Scholar] [CrossRef]
Castro, S. L., Martins, L., & Cunha, L. (2003). Neuropsychological screening with a Portuguese Stroop Test. Poster session presented at the 111th Annual Convention of the American Psychological Association (pp. 1-4), Toronto, Canada. [Google Scholar]
Cavaco, S., Gonçalves, A., Pinto, C., Almeida, E., Gomes, F., Moreira, I., . . . Teixeira-Pinto, A. (2013). Semantic fluency and phonemic fluency: regression-based norms for the Portuguese population. Archives of Clinical Neuropsychology, 28(3), 262-271. [Google Scholar] [CrossRef]
Chang, A. (2013). StatsToDo (Sample size for estimating a single alpha program) (online calculator). Brisbane, Queensland, Austrália. [Google Scholar] [URL]
Chong, M. S., Lim, W. S., Chan, S. P., Feng, L., Niti, M., Yap, P., . . . Ng, T. P. (2010). Diagnostic performance of the Chinese Frontal Assessment Battery in early cognitive impairment in an Asian population. Dementia and Geriatric Cognitive Disorders, 30(6), 525-532. [Google Scholar] [CrossRef]
Cicerone, K. D., Dahlberg, C., Kalmar, K., Langenbahn, D. M., Malec, J. F., Bergquist, T. F., . . . Morse, P. A. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine and Rehabilitation, 81(12), 1596-1615. [Google Scholar] [CrossRef]
Conti, J., Sterr, A., Brucki, S. M. D., & Conforto, A. B. (2015). Diversity of approaches in assessment of executive functions in stroke: Limited evidence?. eNeurologicalSci, 1(1), 12-20. [Google Scholar] [CrossRef]
Delbari, A., Salman Roghani, R., Tabatabaei, S. S., Rahgozar, M., & Lokk, J. (2011). Stroke epidemiology and one-month fatality among an urban population in Iran. International Journal of Stroke, 6(3), 195-200. [Google Scholar] [CrossRef]
Dubois, B., Slachevsky, A., Litvan, I., & Pillon, B. (2000). The FAB: A Frontal Assessment Battery at bedside. Neurology, 55(11), 1621-1626. [Google Scholar] [CrossRef]
Duro, D., Simões, M. R., Ponciano, E., & Santana, I. (2010). Validation studies of the Portuguese experimental version of the Montreal Cognitive Assessment (MoCA): Confirmatory factor analysis. Journal of Neurology, 257(5), 728-734. [Google Scholar] [CrossRef]
Espirito-Santo, H., & Daniel, F. (2015). Calcular e apresentar tamanhos do efeito em trabalhos científicos (1): As limitações do p < 0,05 na análise de diferenças de médias de dois grupos - Folha de cálculo suplementar. Revista Portuguesa de Investigação Comportamental e Social, 1(1), 3-16. [Google Scholar] [CrossRef]
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191. [Google Scholar] [CrossRef]
Feigin, V. L., Forouzanfar, M. H., Krishnamurthi, R., Mensah, G. A., Connor, M., Bennett, D. A., . . . the GBD Stroke Experts Group. (2014). Global and regional burden of stroke during 1990–2010: Findings from the Global Burden of Disease Study 2010. The Lancet, 383(9913), 245-255. [Google Scholar] [CrossRef]
Feigin, V. L., Lawes, C. M., Bennett, D. A., & Anderson, C. S. (2003). Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. The Lancet Neurology, 2(1), 43-53. [Google Scholar] [CrossRef]
Fisk, J., & Sharp, C. A. (2004). Age-related impairment in executive functioning: Updating, inhibition, shifting, and access. Journal of Clinical and Experimental Neuropsychology, 26(7), 874-890. [Google Scholar] [CrossRef]
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(3), 189-198. [Google Scholar] [CrossRef]
Foulkes, M. A., Wolf, P. A., Price, T. R., Mohr, J. P., & Hier, D. B. (1988). The Stroke Data Bank: Design, methods, and baseline characteristics. Stroke, 19(5), 547-554. [Google Scholar] [CrossRef]
Freitas, S., Simões, M. R., Marôco, J., Alves, L., & Santana, I. (2012). Construct validity of the Montreal Cognitive Assessment (MoCA. Journal of the International Neuropsychological Society, 18(2), 242-250. [Google Scholar] [CrossRef]
Garcia, I. Q., Pessoa, I. A., Monteiro, B., Daniel, F., Lemos, L., & Espirito-Santo, H. (2016). Propriedades psicométricas da versão Torga do Teste Stroop. Revista Portuguesa de Investigação Comportamental e Social, 2(2), 55-64. [Google Scholar] [CrossRef]
Hacke, W., Kaste, M., Bogousslavsky, J., Brainin, M., Chamorro, A., Lees, K., . . . Bath, P. (2003). AVC isquémico – profilaxia e tratamento: Informação para médicos hospitalares e medicina ambulatória. Recomendações 2003 – Portugal. European Stroke Initiative, Heidelberg, Alemanha. [Google Scholar] [URL]
Howard, G., & Grau, A. (2014). Advances in stroke: Population studies 2013. Stroke, 45(2), 368-370. [Google Scholar] [CrossRef]
Iavarone, A., Ronga, B., Pellegrino, L., Loré, E., Vitaliano, S., Galeone, F., & Carlomagno, S. (2004). The Frontal Assessment Battery (FAB): Normative data from an Italian sample and performances of patients with Alzheimer's disease and frontotemporal dementia. Functional Neurology, 19(3), 191-195. [Google Scholar] [URL]
Investigators, W. M. P. P. (1988). The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): A major international collaboration. Journal of Clinical Epidemiology, 41(2), 105-114. [Google Scholar] [CrossRef]
Kennedy, M. R. T., Coelho, C., Turkstra, L., Ylvisaker, M., Moore Sohlberg, M., Yorkston, K., . . . Kan, P. F. (2008). Intervention for executive functions after traumatic brain injury: A systematic review, meta-analysis and clinical recommendations. Neuropsychological Rehabilitation, 18(3), 257-299. [Google Scholar] [CrossRef]
Kim, H. Y. (2013). Statistical notes for clinical researchers: Assessing normal distribution (2) using skewness and kurtosis. Restorative Dentistry & Endodontics, 38(1), 52-54. [Google Scholar] [CrossRef]
Kume, K., Hanyu, H., Murakami, M., Sato, T., Hirao, K., Kanetaka, H., . . . Iwamoto, T. (2011). Frontal Assessment Battery and brain perfusion images in amnestic mild cognitive impairment. Geriatrics & Gerontology International, 11(1), 77-82. [Google Scholar] [CrossRef]
Lavados, P. M., Hennis, A. J., Fernandes, J. G., Medina, M. T., Legetic, B., Hoppe, A., . . . Salinas, R. (2007). Stroke epidemiology, prevention, and management strategies at a regional level. Latin America and the Caribbean. The Lancet Neurology, 6(4), 362-372. [Google Scholar] [CrossRef]
Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tranel, D. (2012). Neuropsychological assessment (5th ed.). New York: Oxford University Press. [Google Scholar]
Lima, C. F., Meireles, L. P., Fonseca, R., Castro, S. L., & Garrett, C. (2008). The Frontal Assessment Battery (FAB) in Parkinson’s disease and correlations with formal measures of executive functioning. Journal of Neurology, 255(11), 1756-1761. [Google Scholar] [CrossRef]
Manschot, S. M., Brands, A. M. A., van_der_Grond, J., Kessels, R. P. C., Algra, A., Kappelle, L. J., & Biessels, G. J. (2006). Brain magnetic resonance imaging correlates of impaired cognition in patients with type 2 diabetes. Diabetes, 55(4), 1106-1113. [Google Scholar] [CrossRef]
Marôco, J. (2014). Análise de Equações Estruturais: Fundamentos teóricos, software & aplicações (2nd ed.). Pêro Pinheiro: ReportNumber. [Google Scholar]
Matsui, H., Udaka, F., Miyoshi, T., Hara, N., Tamura, A., Oda, M., . . . Kameyama, M. (2006). Frontal Assessment Battery and brain perfusion image in Parkinson’s disease. Journal of Geriatric Psychiatry and Neurology, 19(1), 41-45. [Google Scholar] [CrossRef]
Meyers, J. E., & Meyers, K. R. (1995). Rey Complex Figure Test and recognition trial professional manual. Lutz, FL: Psychological Assessment Resources. [Google Scholar]
Mok, V. C. T., Wong, A., Yim, P., Fu, M., Lam, W. W. M., Hui, A. C., . . . Wong, K. S. (2004). The validity and reliability of Chinese Frontal Assessment Battery in evaluating executive dysfunction among Chinese patients with small subcortical Infarct. Alzheimer Disease & Associated Disorders, 18(2), 68-74. [Google Scholar] [CrossRef]
Morgado, J., Rocha, C. S., Maruta, C., Guerreiro, M., & Martins, I. P. (2009). Novos valores normativos do Mini-Mental State Examination. Sinapse, 9(2), 10-16. [Google Scholar] [URL]
Nagata, T., Shinagawa, S., Ochiai, Y., Aoki, R., Kasahara, H., Nukariya, K., & Nakayama, K. (2010). Association between executive dysfunction and hippocampal volume in Alzheimer's disease. International Psychogeriatrics, 23(5), 764-771. [Google Scholar] [CrossRef]
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., . . . Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699. [Google Scholar] [CrossRef]
O’Keeffe, S.T., Mulkerrin, E. C., Nayeem, K., Varughese, M., & Pillay, I. (2005). Use of serial Mini-Mental State Examinations to diagnose and monitor delirium in elderly hospital patients. Journal of the American Geriatrics Society, 53(5), 867-870. [Google Scholar] [CrossRef]
Oguro, H., Yamaguchi, S., Abe, S., Ishida, Y., Bokura, H., & Kobayashi, S. (2006). Differentiating Alzheimer’s disease from subcortical vascular dementia with the FAB test. Journal of Neurology, 253(11), 1490-1494. [Google Scholar] [CrossRef]
Osterrieth, P. A. (1944). Le test de copie d’une figure complexe, contribution à l’étude de la perception et de la mémoire [Test of copying a complex figure; contribution to the study of perception and memory] . Archives de Psychologie, 30, 206-356. [Google Scholar]
O’Sullivan, S. B. (2006) Stroke. In O’Sullivan, S. B., & T. J. Schmitz (Eds.), Physical rehabilitation (5th ed., pp. 705–776). Philadelphia: F. A. Davis Company. [Google Scholar]
Pallant, J. (2011). SPSS Survival manual: A step by step guide to data analysis using SPSS for Windows (4th ed.). Crows Nest: Allen & Unwin. [Google Scholar]
Pearson, L. C., & Hall, B. W. (1993). Initial construct validation of the Teaching Autonomy Scale. Journal of Educational Research, 86(3), 172-178. [Google Scholar] [CrossRef]
Pestana, M. H., & Gageiro, J. N. (2014). Análise de dados para ciências sociais - A complementaridade do SPSS (6th ed.). Lisboa: Edições Sílabo. [Google Scholar]
Peterson, R. A. (1994). A meta-analysis of Cronbach's coefficient alpha. Journal of Consumer Research, 21(2), 381-391. [Google Scholar] http://www.jstor.org/stable/2489828 "> [JSTOR]
Philippot, P., & Agrigoroaei, S. (2016). Repetitive thinking, executive functioning, and depressive mood in the elderly. Aging & Mental Health, 2016, 1-5. [Google Scholar] [CrossRef]
Raz, N., Rodrigue, K. M., & Acker, J. D. (2004). Hypertension and the brain: Vulnerability of the prefrontal regions and executive functions. Behavioral Neuroscience, 117(6), 1169-1180. [Google Scholar] [CrossRef]
Rey, A. (1941). L’examen psychologique dans les cas d’encéphalopathie traumatique. (Les problems). Archives de Psychologie, 28, 215-285. [Google Scholar]
Rocha, A. M., & Coelho, M. H. (1988). Teste de cópia de figuras complexas: Manual. Lisboa: CEGOC-TEA. [Google Scholar]
Ropper, A. H., & Brown, R. H. (2005). Adams and Victor's: Principles of neurology (8th ed.). New York: McGraw-Hill Profession. [Google Scholar]
Rosamond, W. D., Folsom, A. R., Chambless, L. E., Wang, C. H., McGovern, P. G., & Shahar, E. (1999). Stroke incidence and survival among middle-aged adults: 9-year follow-up of the atherosclerosis risk in communities (ARIC) cohort. Stroke, 30(4), 736-743. [Google Scholar] [CrossRef]
Santana, I., Duro, D., Lemos, R., Costa, V., Pereira, M., Simões, M. R., & Freitas, S. (2016). Mini-Mental State Examination: Screening and diagnosis of cognitive decline, using new normative data. Acta Médica Portuguesa, 29(4), 240-248. [Google Scholar] [CrossRef]
Saxby, B. K., Harrington, F., McKeith, I. G., Wesnes, K., & Ford, G. A. (2003). Effects of hypertension on attention, memory, and executive function in older adults. Health Psychology, 22(6), 587-591. [Google Scholar] [CrossRef]
Sheehan, D. V., Lecrubier, Y., Harnett Sheehan, K., Janavs, J., Weiller, E., Keskiner, A., . . . Dunbar, G. C. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12(5), 232-241. [Google Scholar] [CrossRef]
Simões, M. R. (2003). Os testes de fluência verbal na avaliação neuropsicológica: Pressupostos, funções examinadas e estruturas anatómicas envolvidas. Psychologica, 32, 25-48. [Google Scholar]
Slachevsky, A., Villalpando, J. M., Sarazin, M., Hahn-Barma, V., Pillon, B., & Dubois, B. (2004). Frontal Assessment Battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Archives of Neurology, 61(7), 1104-1107. [Google Scholar] [CrossRef]
Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643-662. [Google Scholar] [CrossRef]
Tang, W. K., Chen, Y., Liang, H., Chu, W. C. W., Mok, V. C. T., Ungvari, G. S., & Wong, K. S. (2014). Cerebral microbleeds as a predictor of 1-year outcome of poststroke depression. Stroke, 45(1), 77-81. [Google Scholar] [CrossRef]
Templeton, G. F. (2011). A two-step approach for transforming continuous variables to normal: Implications and recommendations for IS research (Vol. 28, Article 4). paper presented at the Communications of the Association for Information. [Google Scholar] [URL]
Terroni, L., Sobreiro, M. F. M., Conforto, A. B., Adda, C. C., Guajardo, V. D., Lucia, M. C. S. de, & Fráguas, R. (2012). Association among depression, cognitive impairment and executive dysfunction after stroke. Dementia & Neuropsychologia, 6(3), 152-157. [Google Scholar] [CrossRef]
Tombaugh, T. N., & McIntyre, N. J. (1992). The Mini‐Mental State Examination: A comprehensive review. Journal of the American Geriatrics Society, 40(9), 922-935. [Google Scholar] [CrossRef]
Trenerry, M. R., Crosson, B., DeBoe, J., & Leber, W. R. (1989). Stroop neuropsychological screening test manual. Odessa, FL: Psychological Assessment Resources. [Google Scholar]
Troyer, A. K., Moscovitch, M., & Winocur, G. (1997). Clustering and switching as two components of verbal fluency: Evidence from younger and older healthy adults. Neuropsychology, 11(1), 138-146. [Google Scholar] [CrossRef]
Varalta, V., Picelli, A., Fonte, C., Amato, S., Melotti, C., Zatezalo, V., . . . Smania, N. (2015). Relationship between cognitive performance and motor dysfunction in patients with Parkinson's disease: A pilot cross-sectional study. BioMed Research International, 2015, 1-6. [Google Scholar] [CrossRef]
Vu, N. Q., & Aizenstein, H. J. (2013). Depression in the elderly: Brain correlates, neuropsychological findings, and role of vascular lesion load. Current Opinion in Neurology, 26(6), 656-661. [Google Scholar] [CrossRef]
Watkins, M. W. (2000). Monte Carlo PCA for parallel analysis [Computer software] . State College, PA: Ed and Psych Associates. [Google Scholar]
Weinstein, A., & Swenson, R. A. (2008) Cerebrovascular disease. In P. J. Snyder, P. D. Nussbaum, & D. L. Robins (Eds.), Clinical Neuropsychology: A pocket handbook for assessment (2nd ed., pp. 294-317). Washington: American Psychological Association. [Google Scholar]
Wolfe, C. D. (2000). The impact of stroke. British Medical Bulletin, 56(2), 275-286. [Google Scholar] [PDF]
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49. [Google Scholar] [CrossRef]
Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3(1), 32-35. [Google Scholar] [CrossRef]
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Helena Espirito-Santo, Inês Queiroz Garcia, Bárbara Monteiro, Naír Carolino, & Fernanda Daniel
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The authors retain the copyright and grant the journal right of first publication with the work simultaneously licensed under the Creative Commons Attribution-NonCommercial 4.0 International License that allows the sharing of work and recognition of authorship and initial publication in this journal.