Utility of the INECO frontal screening (IFS) in the detection of executive dysfunction in patients with relapsing-remitting multiple sclerosis (RRMS)

Dementia and Mild Cognitive Impairment Identification in Illiterate and Low-Educated People: Systematic Review About the Use of Brief Cognitive Screening Tools

The rising prevalence of dementia, particularly in low-income and developing countries, highlights the urgent need for effective cognitive screening tools. However, the existing tools often fail to address the unique needs of low-educated and illiterate populations, leading to diagnostic disparities. This review aimed to evaluate cognitive screening tests and domains employed globally to detect mild cognitive impairment (MCI) and dementia in low-educated and illiterate older adults. Following the PRISMA guidelines, Searches were performed in Web of Science, Scopus, and PubMed, targeting studies from January 2000 to 2023 involving adults over 45 years old. Of 1611 studies identified, 27 met the inclusion criteria and underwent pair review. The results revealed that most studies preferred adapting the existing tools to local languages over developing culturally tailored instruments. Twelve cognitive tests specifically designed for low-educated populations were identified, with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) being the most utilized, despite their educational biases. Adjusting the cutoff points improved detection (e.g., MoCA: sensitivity 82.5%, specificity 82%). Notably, the Rowland Universal Dementia Assessment Scale (RUDAS) demonstrated superior performance for low-educated groups (sensitivity 89% and specificity 93%). The findings underscore the critical need for region-specific cognitive batteries that integrate functional assessments, ensuring equitable and accurate diagnosis across diverse educational backgrounds.

The Moderating Role of Online Awareness in the Association between Strategy Use and Performance Accuracy on a Test of Functional Cognition in Individuals with Acquired Brain Injury

OBJECTIVE

Deficits in online self-awareness (SA) are common after acquired brain injury (ABI), leading to safety concerns and impacting daily activities and rehabilitation outcomes. Early identification is recommended as a critical first step in cognitive rehabilitation following ABI. The aim of this observational study was to examine differences in online SA and strategy use between individuals with ABI and healthy controls. It also investigated whether online SA moderates the relationship between strategy use and performance accuracy on a test designed to assess cognitive-functional deficits.

METHOD

80 individuals with ABI and 76 controls completed the Spanish Weekly Calendar Planning Activity-10. Measures of online SA included strategy use and self-recognized errors assessed during task. An after-task interview assessed individuals' self-evaluation of task difficulty and accuracy of performance.

RESULTS

Individuals with ABI performed worse than controls on most measures of online SA. They were less likely to self-recognize errors and use self-monitoring strategies. They also tended to overestimate their performance and showed greater discrepancy between self-rated and actual performance. Moderation analyses show that better performance was significantly associated with greater strategy use among ABI individuals who were aware of their performance.

CONCLUSIONS

Online SA appears to moderate the use of cognitive strategies during functional cognitive performance after ABI. Therefore, it is important to include assessments of online SA and strategy use for individuals with ABI. Furthermore, these findings highlight the importance of focusing on SA and self-generated strategies as key goals of cognitive rehabilitation aimed at improving daily functioning after ABI.

Translation, cross-cultural adaptation and validation of the 10-item Weekly Calendar Planning Activity in Spanish-speaking ABI patients: a multicenter study

We present the process of translation, adaptation, and validation in the Spanish context of the 10-item version of the Weekly Calendar Planning Activity (WCPA-10), a performance-based measure of cognitive instrumental activities of daily living (C-IADL). The study consisted of two phases: I) translation/cultural adaptation of the WCPA, conducted by professional bilingual translators, a panel of experts, and a pilot study, and II) validation in a sample of 42 acquired brain injury patients (ABI) and 42 healthy participants (HC). WCPA primary outcomes showed expected convergent/discriminant validity patterns with socio-demographical and clinical variables and cognitive processes identifying those WCPA outcomes that best predicted executive and memory deficits measured with a battery of traditional neuropsychological tests. In addition, performance on the WCPA was a significant predictor of everyday functioning over variables such as socio-demographics or global cognition when measured with traditional tests. External validity was established by the WCPA's ability to identify everyday cognitive deficits in ABI patients compared to HC, even in those with subtle cognitive impairment based on neuropsychological tests. The Spanish WCPA-10 seems an appropriate and sensitive assessment tool to identify cognitive-functional impairment in ABI-patients, even those with subtle cognitive impairment. The results also highlight the relevance of this kind of test, as they indicate a better prediction of patients' real-world functioning than traditional neuropsychological tests.

Sensitivity and specificity of the INECO frontal screening (IFS) in the detection of patients with traumatic brain injury presenting executive deficits

Executive dysfunction (EF) is a common feature of adult traumatic brain injury (TBI), especially in moderate to severe cases. Assessing EF usually requires the administration of an extensive neuropsychological battery, which is time consuming and expensive. The INECO frontal screening (IFS) is a brief, easy-to-administer screening test which has previously shown to be useful in the detection of executive deficits in different psychiatric and neurological populations. The aim of the present study was to assess the usefulness of the IFS in the detection of executive dysfunction in TBI patients. Twenty-eight TBI patients and thirty-two healthy controls were assessed with a battery that included classical executive tests and the IFS. Our results indicated that with a cutoff score of 26.25 points, the IFS showed good sensitivity and specificity in the detection of executive impairments in TBI patients. It also showed good positive and negative predicted values. Our results suggest that the IFS can be considered a useful tool for identifying executive dysfunction in patients with TBI.

Neurocognitive factorial structure of executive functions: Evidence from neurotypicals and frontotemporal dementia

The latent structure of executive functions (EFs) remains controversial. Confirmatory factorial analysis (CFA) has provided support for both multidimensional (assumes EFs to be functionally separable but related components) and bifactor (proposes all components are nested within a common factor) models. However, these CFA models have never been compared in patient samples, nor regarding their neuroanatomical correlates. Here, we systematically contrast both approaches in neurotypicals and in a neurodegenerative lesion model (patients with the behavioral variant frontotemporal dementia, bvFTD), characterized by executive deficits associated with frontal neurodegeneration. First, CFA was used to test the models' fit in a sample of 341 neurotypicals and 29 bvFTD patients based on performance in an executive frontal screening battery which assesses working memory, motor inhibition, verbal inhibition, and abstraction capacity. Second, we compared EFs factor and observed scores between patients and matched controls. Finally, we used voxel-based morphometry (VBM) to compare the grey matter correlates of factor and observed scores. CFA results showed that both models fit the data well. The multidimensional model, however, was more sensitive than the bifactor model and the observed scores to detect EFs impairments in bvFTD patients. VBM results for the multidimensional model revealed common and unique grey matter correlates for EFs components across prefrontal-insular, posterior, and temporal cortices. Regarding the bifactor model, only the common factor was associated with prefrontal-insular hubs. Observed scores presented scant, non-frontal grey matter associations. Converging behavioral and neuroanatomical evidence from healthy populations and a neurodegenerative model of EFs supports an underlying multidimensional structure.

Evaluation of sensitivity and specificity of the INECO Frontal Screening and the Frontal Assessment Battery in mild cognitive impairment

The Frontal Assessment Battery (FAB) and the INECO Frontal Screening (IFS) are two instruments frequently used to explore cognitive deficits in different diseases. However, studies reporting their use in patients with mild cognitive impairment (MCI) are limited.

The impact of legal expertise on moral decision-making biases

Traditional and mainstream legal frameworks conceive law primarily as a purely rational practice, free from affect or intuition. However, substantial evidence indicates that human decision-making depends upon diverse biases. We explored the manifestation of these biases through comparisons among 45 criminal judges, 60 criminal attorneys, and 64 controls. We examined whether these groups' decision-making patterns were influenced by (a) the information on the transgressor's mental state, (b) the use of gruesome language in harm descriptions, and (c) ongoing physiological states. Judges and attorneys were similar to controls in that they overestimated the damage caused by intentional harm relative to accidental harm. However, judges and attorneys were less biased towards punishments and harm severity ratings to accidental harms. Similarly, they were less influenced in their decisions by either language manipulations or physiological arousal. Our findings suggest that specific expertise developed in legal settings can attenuate some pervasive biases in moral decision processes.

Validation of the RUDAS in Patients With a Middle-Level Education in Lima, Peru

OBJECTIVES

To assess the psychometric properties of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) to discriminate controls from patients with mild cognitive impairment (MCI) and early dementia (ED) in a population with a mid-level education.

METHODS

A total of 133 patients from a memory clinic were administered the RUDAS-PE, INECO Frontal Screening, Addenbrooke's Cognitive Examination, and Mini-Mental State Examination. Results were compared against a neuropsychological evaluation (gold standard). Validity measures, internal consistency, and concurrent validity were calculated.

RESULTS

Cronbach's α was 0.68; Pearson's ratio was 0.79 (P < .01). The area under the receiver-operating characteristics curve of the RUDAS to discriminate between ED and MCI was 89.0% (optimal cutoff at <21), whereas between MCI and controls, it was 99.0% (optimal cutoff at <24).

CONCLUSIONS

The RUDAS-PE has acceptable psychometric properties performing well in its ability to discriminate controls from patients with MCI and ED.

The Accuracy of INECO Frontal Screening in the Diagnosis of Executive Dysfunction in Frontotemporal Dementia and Alzheimer Disease

INTRODUCTION

Executive dysfunction is a common symptom in neurodegenerative disorders and is in need of easy-to-apply screening tools that might identify it. The aims of the present study were to examine some of the psychometric characteristics of the Brazilian version of the INECO frontal screening (IFS), and to investigate its accuracy to diagnose executive dysfunction in dementia and its accuracy to differentiate Alzheimer disease (AD) from the behavioral variant of frontotemporal dementia (bvFTD).

METHODS

Patients diagnosed with bvFTD (n=18) and AD (n=20), and 15 healthy controls completed a neuropsychological battery, the Neuropsychiatric Inventory, the Cornell Scale for Depression in Dementia, the Clinical Dementia Rating, and the IFS.

RESULTS

The IFS had acceptable internal consistency (α=0.714) and was significantly correlated with general cognitive measures and with neuropsychological tests. The IFS had adequate accuracy to differentiate patients with dementia from healthy controls (AUC=0.768, cutoff=19.75, sensitivity=0.80, specificity=0.63), but low accuracy to differentiate bvFTD from AD (AUC=0.594, cutoff=16.75, sensitivity=0.667, specificity=0.600).

CONCLUSION

The present study suggested that the IFS may be used to screen for executive dysfunction in dementia. Nonetheless, it should be used with caution in the differential diagnosis between AD and bvFTD.

Assessing Executive Dysfunction in Neurodegenerative Disorders: A Critical Review of Brief Neuropsychological Tools

Executive function (EF) has been defined as a multifaceted construct that involves a variety of high-level cognitive abilities such as planning, working memory, mental flexibility, and inhibition. Being able to identify deficits in EF is important for the diagnosis and monitoring of several neurodegenerative disorders, and thus their assessment is a topic of much debate. In particular, there has been a growing interest in the development of neuropsychological screening tools that can potentially provide a reliable quick measure of EF. In this review, we critically discuss the four screening tools of EF currently available in the literature: Executive Interview-25 (EXIT 25), Frontal Assessment Battery (FAB), INECO Frontal Screening (IFS), and FRONTIER Executive Screen (FES). We first describe their features, and then evaluate their psychometric properties, the existing evidence on their neural correlates, and the empirical work that has been conducted in clinical populations. We conclude that the four screening tools generally present appropriate psychometric properties, and are sensitive to impairments in EF in several neurodegenerative conditions. However, more research will be needed mostly with respect to normative data and neural correlates, and to determine the extent to which these tools add specific information to the one provided by global cognition screening tests. More research directly comparing the available tools with each other will also be important to establish in which conditions each of them can be most useful.

Cognitive and neuropsychiatric disorders among MS patients from Latin America

Cognitive and neuropsychiatric disorders in patients with multiple sclerosis have been extensively documented. The focus of this review will be on cognitive and neuropsychiatric disorders in multiple sclerosis patients from Latin America, in the context of international literature. Multicentre studies carried out in Latin America have shown that 43% of the patients have cognitive impairment and 34.5% in early stages of the disease, 29% depression and 20.9% neuropsychiatric disorders. The profile of cognitive impairment corresponds to alterations in visual and verbal memory, in attention, in information processing speed and in verbal fluency. The neuropsychiatric profile showed disorders in anxiety, depression, apathy and irritability domains. In the region, there exist validations of the multiple sclerosis neuropsychological screening questionnaire (MSNQ), the brief repeatable battery of neuropsychological tests (BRB-N) and the brief international cognitive assessment for multiple sclerosis (BICAMS), as well as of the paced auditory serial addition test (PASAT) and the symbol digit modalities test (SDMT). A study showed that 53% of the patients who met the NEDA3 condition had cognitive impairment. This finding highlights the need for taking cognitive assessment into account when determining therapeutic efficacy.

Evaluation of the INECO Frontal Screening and the Frontal Assessment Battery in Peruvian patients with Alzheimer's disease and behavioral variant Frontotemporal dementia

Background

The physicians often confuse the early symptoms of Frontotemporal dementia (FTD) with Alzheimer dementia (AD), leading to misdiagnosis. There are some cognitive tests to discriminate between AD and behavioral variant FTD (bvFTD), and the INECO Frontal Screening (IFS) is a promising test for this purpose.

Objective

To assess the performance of the IFS to differentiate patients with AD from patients with bvFTD, compared with the Frontal Assessment Battery (FAB).

Methods

A prospective study with 117 patients of our cognitive unit (35 case-patients with AD, 34 case-patients with bvFTD, and 48 control subjects). They were submitted to the following successive phases of evaluation: 1) screening; 2) dementia diagnosis; and 3) dementia sub-type diagnosis. The IFS and FAB were blind and independently applied by one neurologist to all the participants to end of phase 1 (screening), before to the definitive diagnosis establishment.

Results

bvFTD showed a lower performance than AD patients on the IFS total score (F(1, 66) = 70.10, p < 0.01) and FAB total score (F(1, 66) = 17.91, p < 0.01). The IFS and FAB showed a sensitivity of 94.12% (95%CI = 80.3–99.2) and 82.3% (95%CI = 65.4–93.2), and a specificity of 94.2% (95%CI = 80.8–99.3) and 48.5% (95%CI = 31.3, 66.1), respectively. The IFS showed significantly superior discriminatory accuracy than the FAB (AuC_IFS = 0.98; AuC_FAB = 0.73, p < 0.00001).

Conclusion

The IFS is useful for discriminating between AD and bvFTD patients. The performance of the IFS to differentiate patients with AD from patients with bvFTD is greater than FAB.

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Early symptoms of FTD are confused with AD.

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In low-income countries is necessary to dispose of validated brief cognitive tests for discriminating between dementia of healthy individuals.

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IFS and FAB are useful cognitive tests for discriminating dementia, but IFS has a good performance to discriminate between AD and FTD.