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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.7 no.1 São Paulo Jan./Mar. 2013

http://dx.doi.org/10.1590/S1980-57642013DN70100007 

ORIGINAL ARTICLES

Chilean version of the INECO Frontal Screening (IFS-Ch): Psychometric properties and diagnostic accuracy

Versão Chilena do Rastreio Frontal INECO: propriedades psicométricas e utilidade diagnóstica

Josefina Ihnen1 

Andrés Antivilo2 

Carlos Muñoz-Neira1 

Andrea Slachevsky3 

1Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador. Santiago, Región Metropolitana, Chile. Universidad de Chile.

2Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Chile. Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Chile.

3Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador. Santiago, Región Metropolitana, Chile. Universidad de Chile. Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Chile. Centro de Investigación Avanzada en Educación, Universidad de Chile. Departamento de Farmacología Molecular y Clínica, ICBM y Departamento de Ciencias Neurológicas Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Servicio de Neurología, Clínica Alemana de Santiago, Región Metropolitana, Chile.

ABSTRACT

Objective:

This study sought to analyze the psychometric properties and diagnostic accuracy of the Chilean version of the INECO Frontal Screening (IFS-Ch) in a sample of dementia patients and control

Methods:

After adapting the instrument to the Chilean context and obtaining content validity evidence through expert consultation, the IFS-Ch was administered to 31 dementia patients and 30 control subjects together with other executive assessments (Frontal Assessment Battery [FAB], Modified version of the Wisconsin Card Sorting Test [MCST], phonemic verbal fluencies [letters A and P] and semantic verbal fluency [animals]) and global cognitive efficiency tests (Mini mental State Examination [MMSE] and Addenbrooke's Cognitive Examination-Revised [ACE-R]). Caregivers of dementia patients and proxies of control subjects were interviewed with instruments measuring dysexecutive symptoms (Dysexecutive Questionnaire [DEX]), dementia severity (Clinical Dementia Rating Scale [CDR]) and functional status in activities of daily living (Activities of Daily Living Scale [IADL] and Technology-Activities of Daily Living Questionnaire [T-ADLQ]). Convergent and discriminant validity, internal consistency reliability, cut-off points, sensitivity and specificity for the IFS-Ch were estimated.

Results:

Evidence of content validity was obtained. Evidence of convergent validity was also found showing significant correlations (p<0.05) between the IFS-Ch and the other instruments measuring: executive functions (FAB, r=0.935; categories achieved in the MCST, r=0.791; perseverative errors in the MCST, r= -0.617; animal verbal fluency, r=0.728; A verbal fluency, r=0.681; and P verbal fluency, r=0.783), dysexecutive symptoms in daily living (DEX, r= -0.494), dementia severity (CDR, r= -0.75) and functional status in activities of daily living (T-ADLQ, r= -0.745; IADL, r=0.717). Regarding reliability, a Cronbach's alpha coefficient of 0.905 was obtained. For diagnostic accuracy, a cut-off point of 18 points (sensitivity=0.903; specificity=0.867) and an area under curve of 0.951 were estimated to distinguish between patients with dementia and control subjects.

Discussion:

The IFS-Ch showed acceptable psychometric properties, supported by evidence of validity and reliability for its use in the measurement of executive functions in patients with dementia. The diagnostic accuracy of the IFS-Ch for detecting dementia patients was also considered acceptable.

Key words: INECO Frontal Screening; executive functions; neuropsychological tests; dementia

RESUMO

Objetivo:

Analisar as propriedades psicométricas e utilitário de diagnóstico da versão chilena do rastreio frontal INECO (IFS-Ch) em uma amostra de pacientes com demência e controles.

Métodos:

Após a adaptação do instrumento para o contexto chileno e obtenção de evidências de validade de conteúdo, o IFS-Ch foi administrado a 31 pacientes com demência e 30 indivíduos do grupo controle, além de outros testes de eficiência cognitiva global e executiva. Cuidadores de pacientes com demência e informantes de indivíduos controles foram entrevistados com instrumentos de medidas de sintomas disexecutivos, gravidade da demência e estado funcional nas atividades da vida diária. Validade convergente e discriminante, consistência interna, pontos de corte, sensibilidade e especificidade para o IFS-Ch foram estimados.

Resultados:

A evidência de validade de conteúdo foi obtida através de consulta a um especialista. Evidências de validade convergente foram encontrados, bem como, descritas correlações significativas entre o IFS-Ch e outros instrumentos de medidas: de funções executivas (FAB, r=0,935; categorias alcançadas no MCST, r=0,791; erros perseverativos na MCST, r= -0,617; fluência verbal animais, r=0,728; "A" de fluência verbal, r=0,681; gravidade de demência e fluência verbal de "P", r=0,783), sintomas disexecutivos na vida diária (DEX, r= -0,494), (CDR, r= -0,75) e estado funcional nas atividades da vida diária (T-ADLQ, r= -0,745; AIVD, r=0,717). Quanto à confiabilidade, coeficiente alfa de Cronbach de 0,905 foi obtido. Quanto a utilidade de diagnóstico, um ponto de corte de 18 pontos (sensibilidade=0,903, especificidade=0,867) e uma área sob a curva de 0,951 foi estimada para distinguir entre pacientes com demência e sujeitos controles.

Discussão:

O IFS-Ch mostra propriedades psicométricas aceitáveis, apoiadas por evidências de validade e confiabilidade para sua utilização como medida de funções executivas em pacientes com demência. Sua utilidade diagnóstica para detectar pacientes com demência também é considerada aceitável.

Palavras-chave: INECO triagem frontal; funções executivas; testes neuropsicológicos; demência

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REFERENCES

Elliott R, Executive functions and their disorders. Br Med Bull 2003; 65:49-59. [ Links ]

Stuss DT, Levine B, Adult clinical neuropsychology: lessons from studies of the frontal lobes. Annu Rev Psychol 2002;53:401-433. [ Links ]

Verdejo A, Bechara A. Neuropsicología de las funciones ejecutivas. Psicothema 2010;22:227-235. [ Links ]

Chan RC, Shum D, Toulopoulou T, Chen EY. Assessment of executive functions: review of instruments and identification of critical issues. Arch Clin Neuropsychol 2008;23:201-216. [ Links ]

Miyake A, Emerson MJ, Friedman NP. Assessment of executive functions in clinical settings: problems and recommendations. Semin Speech Lang 2000;21:169-183. [ Links ]

Stuss DT, Alexander MP. Executive functions and the frontal lobes: a conceptual view. Psychol Res 2000;63:289-298. [ Links ]

Godefroy O. Frontal syndrome and disorders of executive functions. J Neurol 2003; 250: 1-6. [ Links ]

Voss SE, Bullock RA. Executive function: the core feature of dementia? Dement Geriatr Cogn Disord 2004;18:207-216. [ Links ]

Torralva T, Martínez M, Manes F. Demencia frontotemporal. In: Labos E, Slachevsky A, Fuentes P, Manes F (editors). Tratado de Neuropsicología Clínica. Buenos Aires, Argentiana: Librería Akadia; 2008:501-509. [ Links ]

Merino J, Hachinski V. Demencia Vascular. In: Labos E, Slachevsky A, Fuentes P, Manes F (editors). Tratado de Neuropsicología Clínica.Buenos Aires, Argentiana:Librería Akadia; 2008:511-519. [ Links ]

Graham NL, Emery T, Hodges JR. Distinctive cognitive profiles in Alzheimer's disease and subcortical vascular dementia. J NeurolNeurosurg Psychiatry 2004;75:61-71. [ Links ]

Cleusa P Ferri, Martin Prince, Carol Brayne, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112-2117. [ Links ]

Torralva T, Roca M, Gleichgerrcht E, López P, Manes F. INECO Frontal Screening (IFS): a brief, sensitive, and specific tool to assess executive functions in dementia. J Int Neuropsychol Soc 2009;15:777-786. [ Links ]

Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000;55:1621-1626. [ Links ]

Sarazin M, Pillon B, Giannakopoulos P, Rancurel G, Samson Y, Dubois B. Clinicometabolic dissociation of cognitive functions and social behavior in frontal lobe lesions. Neurology1998;51:142-148. [ Links ]

Lipton AM, Ohman KA, Womack KB, Hynan LS, Ninman ET, Lacritz LH. Subscores of the FAB differentiate frontotemporal lobar degeneration from AD. Neurology2005;65:726-731. [ Links ]

American Psychiatric Association. and American Psychiatric Association. Task Force on DSM-IV., Diagnostic and statistical manual of mental disorders : DSM-IV. 4th ed, Washington, DC: American pyschiatric association. 1994: xxvii, 886. [ Links ]

McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology1984;34:939-944. [ Links ]

Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology1998; 51:1546-1554. [ Links ]

McKeith IG, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology1996;47:1113-1124. [ Links ]

Román GC, Tatemichi TK, Erkinjuntti T, et al., Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology1993;43:250-260. [ Links ]

Grant DA, Berg EA, A behavioural analysis of degree or reinforcement and ease of shifting to new responses in a Weigl-type card sorting problem. J Exp Psychology 1948; 38:404-411. [ Links ]

Berg EA. A simple objective technique for measuring flexibility in thinking. J Gen Psychol 1948;39:15-22. [ Links ]

Hodges JR. Cognitive assessment for clinicians. 2nd ed, Oxford ; New York: Oxford University Press. 2007:266, xviii [ Links ]

Nelson HE. A modified card sorting test sensitive to frontal lobe defects. Cortex 1976;12:313-324. [ Links ]

Henry JD, Crawford JR, A meta-analytic review of verbal fluency performance in patients with traumatic brain injury. Neuropsychology 2004; 18:621-628. [ Links ]

Benton A, Hamsher K. Multilingual aphasia examination manual, Iowa: Universidad de Iowa; 1976. [ Links ]

Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198. [ Links ]

Mangone C, Bauman D, Gigena V. Evaluación neuropsicológica de las demencias. In: Labos E, Slachevsky A, Fuentes P, Manes F (editors). Tratado de Neuropsicología Clínica. Buenos Aires, Argentiana: Librería Akadia; 2008:483-491. [ Links ]

Muñoz-Neira C, Henríquez Ch F, Ihnen J J, Sánchez C M, Flores M P, Slachevsky Ch A. Psychometric properties and diagnostic usefulness of the Addenbrooke's Cognitive Examination-revised in a Chilean elderly sample. Rev Med Chil 2012;140:1006-1013. [ Links ]

Wilson BA, Emslie H, Evans JJ, Alderman N, Burgess PW. Behavioural Assessment of the Dysexecutive Syndrome (BADS) Bury St. Edmunds: Thames Valley Test Company; 1996. [ Links ]

Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572. [ Links ]

Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9: 179-186. [ Links ]

Muñoz-Neira C, López OL, Riveros R, Núñez-Huasaf J, Flores P, Slachevsky A. The technology - activities of daily living questionnaire: a version with a technology-related subscale. Dement Geriatr Cogn Disord 2012;33:361-371. [ Links ]

Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839-843. [ Links ]

Burgess PW, Alderman N, Evans J, Emslie H, Wilson B. The ecological validity of tests of executive function. J Int Neuropsychol Society 1998;4:547-558. [ Links ]

Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis. Cogn Psychol 2000;41:49-100. [ Links ]

Heaton RK, Grant I, Mathews C. Differences in neuropsychological test performances associated with age, education and sex. In: Grant I, Adams KM (Editors). Neuropsychological assessment in neuropsychiatric disorders. Oxford University Press: Nueva York; 1986:108-120. [ Links ]

Ivnik RJ, Malec JF, Smith GE, et al. Neuropsychological tests' norms above age 55: COWAT, BNT, MAE Token, WRAT-R Reading, AMNART, Stroop, TMT, and JLO. Clin Neuropsychologist 1996;10:262-278. [ Links ]

Mortiner JA, Graves AB, Education and other socioeconomic determinants of dementia and Alzheimer's Disease. Neurology1993;43:39-44. [ Links ]

Royall DR, Lauterbach EC, Cummings JL, et al., Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 2002;14:377-405. [ Links ]

Royall DR, Lauterbach EC, Kaufer D, Malloy P, Coburn KL, Black KJ, Committee on Research of the American Neuropsychiatric Association.The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci2007;19:249-265. [ Links ]

Godefroy O, Azouvi P, Robert P, Roussel M, LeGall D, Meulemans T; Groupe de Réflexion sur l'Evaluation des Fonctions Exécutives Study Group. Dysexecutive syndrome: diagnostic criteria and validation study. Ann Neurol 2010;68:855-864. [ Links ]

Manchester D, Priestley N, ackson H, The assessment of executive functions: coming out of the office. Brain Inj 2004;18:1067-1081. [ Links ]

Received: November 04, 2012; Accepted: January 08, 2013

Andrea Slachevsky. Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador - Avenida Salvador 364 - Santiago - Región Metropolitana - Chile. E-mail: aslachevsky@me.com

Disclosure: The authors report no conflicts of interest.

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