The influence of reading and writing habits associated with education on the neuropsychological...

The influence of reading and writing habits associatedwith education on the neuropsychological performanceof 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

� 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, mem-

ory, 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 Autonoma 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, Pavilhao 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

123

Read Writ (2012) 25:2275–2289

DOI 10.1007/s11145-012-9357-8

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 indi-

viduals, 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-Solıs et al., 2007; Pena-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-Solıs 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 perfor-

mance, 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

2276 J. Pawlowski et al.

123

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). Bramao 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 improve-

ment 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

The influence of reading and writing habits 2277

123

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.


123

Ta

ble

1D

escr

ipti

on

of

the

six

gro

ups

of

educa

tion/f

requen

cyof

read

ing

and

wri

ting

hab

its

(RW

H)

Gro

ups

0–4

yea

rso

fed

uca

tion

5–11

yea

rsof

educa

tion

12–23

yea

rsof

educa

tion

;R

WH

:R

WH

;R

WH

:R

WH

;R

WH

:R

WH

N9

53

61

20

10

63

01

02

Ag

eM

(SD

)5

3.1

4(1

6.6

7)

46

.44

(19

.10

)4

9.9

7(1

8.9

6)

50

.25

(17

.55)

59

.20

(19

.45)

44

.11

(18

.74)

Ed

uca

tio

nM

(SD

)3

.39

(0.7

5)

3.5

1(0

.65

)7

.42

(2.1

2)

8.1

0(2

.26

)1

5.1

3(2

.66

)1

5.7

3(2

.46

)

Sex

wo

men

/men

72

/23

22

/14

83

/37

79

/27

21

/97

0/3

2

;R

WH

low

read

ing

and

wri

tin

gh

abit

s(B

11

po

ints

)an

d:

RW

Hh

igh

read

ing

and

wri

tin

gh

abit

([1

1p

oin

ts)


123

Table 2 Cognitive functions,

components, tasks and scores in

NEUPSILIN, adapted from

Fonseca, Salles, and Parente

(2008)

Cognitive

functions

Components and tasks Scores

1. Orientation 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

3.2 Visual hemineglect 0–1

3.3 Face perception 0–3

3.4 Face recognition 0–2

4. Memory 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 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. Praxis 7.1 Ideomotor 0–3

7.2 Constructional 0–16

7.3 Reflexive 0–3

8. Executive

functions

8.1 Problem solving 0–2

8.2 Verbal fluency 0–7


123

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.


123

Fig. 1 z-scores in NEUPSILIN tasks by groups of education and reading and writing habits (RWH)


123

Ta

ble

3O

ne-

way

anal

ysi

so

fv

aria

nce

and

dif

fere

nce

sb

etw

een

gro

ups

inth

eta

sks

of

NE

UP

SIL

IN

Gro

ups

0–4

yea

rsof

educa

tion

5–11

yea

rsof

educa

tion

12–23

yea

rsof

educa

tion

F

;R

WH

:R

WH

;R

WH

:R

WH

;R

WH

:R

WH

Tas

ks

of

NE

UP

SIL

INM

(SD

)M

(SD

)M

(SD

)M

(SD

)M

(SD

)M

(SD

)

Tim

eori

enta

tion

3.7

6(0

.56)a

3.6

9(0

.52

)a3

.79

(0.4

5)a

3.8

7(0

.34

)a3

.73

(0.5

2)a

3.9

4(0

.27

)a3

.20

Spac

eori

enta

tion

3.8

9(0

.31)a

3.9

2(0

.37

)a3

.99

(0.0

9)a

3.9

7(0

.22

)a4

.00

(0.0

0)a

4.0

0(0

.00

)a3

.97

Inv

erse

cou

nti

ng

15

.33

(6.7

4)a

16

.69

(6.5

)a,b

18

.32

(4.3

8)b

18

.99

(3.1

4)b

19

.17

(3.3

0)b

19

.71

(2.0

1)b

11

.73

*

Dig

itse

qu

ence

rep

etit

ion

2.0

2(1

.41

)a2

.64

(1.7

4)a

,b3

.10

(1.9

2)b

3.2

6(1

.95

)b3

.17

(1.8

4)a

,b3

.93

(2.0

1)b

11

.29

*

Ver

ifica

tion

of

lines

5.1

6(1

.11)a

5.3

3(0

.93

)a5

.28

(1.0

1)a

5.3

3(1

.04

)a5

.27

(1.0

8)a

5.6

2(0

.76

)a2

.37

Vis

ual

hem

ineg

lect

1.0

0(0

.00

)a1

.00

(0.0

0)a

1.0

0(0

.00

)a1

.00

(0.0

0)a

1.0

0(0

.00

)a1

.00

(0.0

0)a

–

Fac

eper

cepti

on

2.1

7(0

.82)a

2.2

5(0

.81

)a2

.36

(0.7

2)a

2.4

6(0

.66

)a2

.53

(0.7

8)a

2.4

1(0

.71

)a2

.29

Fac

ere

cog

nit

ion

1.8

0(0

.40

)a1

.75

(0.4

4)a

1.8

3(0

.42

)a1

.92

(0.2

6)a

1.9

3(0

.25

)a1

.96

(0.1

9)a

4.1

9

Asc

end

ant

ord

erin

go

fd

igit

s4

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(2.4

3)a

4.9

7(2

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)a6

.55

(1.9

8)b

6.8

5(1

.93

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(1.4

7)b

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(1.6

5)c

39

.84

*

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lw

ord

span

inse

nte

nce

s9

.51

(5.3

8)a

10

.11

(5.5

4)a

,b1

3.0

7(4

.37

)b,c

14

.43

(4.9

)c1

3.9

0(4

.83

)b,c

19

.08

(5.4

8)d

40

.71

*

Imm

edia

tere

call

4.0

7(1

.49

)a4

.22

(1.1

0)a

4.4

3(1

.34

)a4

.72

(1.3

8)a

4.8

0(1

.32

)a,b

5.6

1(1

.59

)b1

3.7

7*

Del

ayed

reca

ll1

.33

(1.6

4)a

1.6

7(1

.69

)a1

.72

(1.7

1)a

2.1

7(1

.86

)a2

.20

(1.9

9)a

,b3

.52

(2.3

4)b

15

.97

*

Rec

ogn

itio

n1

1.6

5(2

.22

)a1

1.8

1(2

.46

)a1

1.9

2(2

.35

)a1

2.3

6(2

.33

)a1

2.6

7(2

.45

)a,b

14

.05

(2.1

9)b

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ng-t

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spec

tive

mem

ory

1.2

6(0

.81)a

1.3

9(0

.80

)a,b

1.4

0(0

.80

)a,b

1.4

8(0

.75

)a,b

1.5

7(0

.73

)a,b

1.7

5(0

.50

)b4

.99

*

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thm

etic

4.4

3(2

.67

)a6

.31

(1.8

6)b

7.1

3(1

.50

)b,c

6.9

4(1

.48

)b,c

7.2

7(0

.98

)b,c

7.8

0(0

.58

)c4

6.9

4*

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ing

3.9

9(0

.10

)a3

.97

(0.1

7)a

4.0

0(0

.00

)a4

.00

(0.0

0)a

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)a4

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(0.0

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Rep

etit

ion

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8(0

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)a9

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(0.6

0)a

,b9

.73

(0.5

9)a

,b9

.88

(0.3

3)b

9.9

0(0

.30

)a,b

9.9

1(0

.32

)b5

.80

*

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tom

ated

lan

gu

age

1.8

8(0

.32

)a1

.86

(0.3

5)a

1.9

7(0

.18

)a1

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(0.2

1)a

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(0.1

0)a

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9

Ora

lco

mp

reh

ensi

on

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1(0

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(0.6

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)a,b

2.8

9(0

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)a,b

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3(0

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)a,b

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8(0

.14

)b6

.66

*

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renti

alpro

cess

ing

2.0

6(0

.78)a

2.0

8(0

.77

)a,b

2.3

5(0

.68

)a,b

,c2

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(0.4

9)c

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(0.6

2)b

,c,d

2.7

8(0

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)d1

7.9

0*


123

Ta

ble

3co

nti

nu

ed

Gro

ups

0–4

yea

rsof

educa

tion

5–11

yea

rsof

educa

tion

12–23

yea

rsof

educa

tion

F

;R

WH

:R

WH

;R

WH

:R

WH

;R

WH

:R

WH

Tas

ks

of

NE

UP

SIL

INM

(SD

)M

(SD

)M

(SD

)M

(SD

)M

(SD

)M

(SD

)

Rea

din

gal

ou

d1

0.2

9(2

.38

)a1

1.0

6(1

.01

)a,b

11

.60

(0.7

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123

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).


123

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 construc-

tional 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


123

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.

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