Alfonso Caracuel

Ecological validity of the Multiple Errands Test using predictive models of dysexecutive problems in everyday life

The“dysexecutive syndrome” is composed of a range of cognitive, emotional, and behavioral deficits that are difficult to evaluate using traditional neuropsychological tests. The Multiple Errands Test (MET) was originally developed to systematize the assessment of the more elusive manifestations of the dysexecutive syndrome. The aims of this study were to examining the reliability of the MET and to investigate the predictive ability of its indices to explain a range of “dysexecutive”-related symptoms in everyday life. Thirty patients with acquired brain injury participated in this study. The MET showed an adequate inter-rater reliability and ecological validity. The main performance indices from the MET were able to significantly predict severity of everyday life executive problems, with different indices predicting particular manifestations of different components of executive functions.

Effects of a multicomponent behavioral intervention on impulsivity and cognitive deficits in adolescents with excess weight.

The aim of this study was to explore the effects of a multidisciplinary behavioral intervention including cognitive behavioral therapy, structured physical activity, and dietary counseling on impulsive personality and cognitive skills and subsequent BMI loss in excess weight adolescents. Forty-two adolescents with excess weight (14 males and 28 females, range 12–17 years), as defined by the International Obesity Task Force Criteria, participated in our study. We used a longitudinal observational design with two assessments: before and after treatment. We collected baseline measures of impulsive personality (UPPS-P scale), cognitive performance (letter number sequencing, Stroop and Iowa gambling task), and biometric parameters. After 12 weeks of intervention, parallel measures were used to determine whether treatment-induced changes in impulsivity and cognition predicted changes in BMI. BMI showed a statistically significant reduction after treatment [from mean (SD) 29.36 (4.51) to 27.31 (4.41), Cohen’s d=0.5]. Greater reductions in negative urgency (negative-emotion-driven impulsivity) and greater improvement in cognitive inhibitory control skills were associated with greater reductions in BMI. Because the design was correlational and lacked a control group, future studies should clarify whether these associations reflect a causal effect or just overlapping improvements associated with a third variable (e.g. increases in attention procurement or motivation).

Functional impairment as a defining feature of: amnestic MCI cognitive, emotional, and demographic correlates

BACKGROUND Early definitions of mild cognitive impairment (MCI) excluded the presence of functional impairment, with preservation of a persons ability to perform activities of daily living (ADL) as a diagnostic criterion. However, recent studies have reported varying degrees of functional impairment associated with MCI. Hence, we aimed to test the potential functional impairment associated with MCI and its predictors. METHODS Sixty-nine healthy elderly subjects, 115 amnestic single-domain MCI subjects (a-MCI), and 111 amnestic multi-domain MCI subjects (md-MCI) were assessed using a battery of neuropsychological tests including measures of attention, memory, working memory, executive functions, language, and depression. Additionally, functional ability was assessed by both qualitative (WHO-DAS II) and quantitative (CHART) instruments. Cognitive and functional performance was compared between groups, and regression analyses were performed to identify predictors of functional ability. RESULTS The md-MCI group was more impaired than the a-MCI group, and both were more impaired than healthy subjects in all cognitive measures, in total CHART score, CHART cognitive and mobility subscores, and WHO-DAS II communication and participation subscales. For the rest of the functional measures, the md-MCI group was more impaired than healthy controls. Prediction of functional ability by cognitive measures was limited to md-MCI subjects and was higher for the CHART than for the WHO-DAS II. The WHO-DAS II was largely influenced by depressive symptoms. CONCLUSIONS Functional impairment is a defining feature of MCI and is partially dependent on the degree of cognitive impairment. Quantitative measures of functional ability seem more sensitive to functional impairment in MCI than qualitative measures, which seem to be more related to depression.

The profession of neuropsychology in Spain: results of a national survey

Abstract Objective: To examine the current status of professional neuropsychology in Spain, with particular focus on the areas of professional training, current work situation, evaluation and diagnostic practice, rehabilitation, teaching, and research. Methods: Three hundred and thirty-nine self-identified professionals in neuropsychology from Spain completed an online survey between July and December of 2013. Respondents had an average age of 35.8 years and 77% were women. Results: Ninety-seven percent of the respondents identified as psychologists; 82% of the sample had a master’s degree, and 33% a doctoral degree. The majority (91%) received their neuropsychological training at a graduate level; 88% engaged in neuropsychological evaluation, 59% in rehabilitation, 50% in research, and 40% in teaching. Average number of hours per week dedicated to work in neuropsychology was 29.7, with 28% of the respondents reporting working in hospitals, 17% in not-for-profit rehabilitation centers, 15% in universities, and 14% in private clinics. Clinicians primarily work with individuals with stroke, traumatic brain injury, and dementia. The top perceived barriers to development of neuropsychology in Spain included lack of clinical and academic training opportunities, and negative attitude toward professional collaboration. Conclusions: The field of neuropsychology in Spain is young and rapidly growing. There is a need to regulate professional neuropsychology, improve graduate curricula, enhance existing clinical training, develop professional certification programs, validate and create normative data for existing neuropsychological tests, and create new, culturally relevant instruments.

Challenges in software applications for the cognitive evaluation and stimulation of the elderly

BackgroundComputer-based cognitive stimulation applications can help the elderly maintain and improve their cognitive skills. In this research paper, our objectives are to verify the usability of PESCO (an open-software application for cognitive evaluation and stimulation) and to determine the concurrent validity of cognitive assessment tests and the effectiveness of PESCO’s cognitive stimulation exercises.MethodsTwo studies were conducted in various community computer centers in the province of Granada. The first study tested tool usability by observing 43 elderly people and considering their responses to a questionnaire. In the second study, 36 elderly people completed pen-and-paper and PESCO tests followed by nine cognitive stimulation sessions. Meanwhile, a control group with 34 participants used computers for nine non-structured sessions.ResultsAnalysis of the first study revealed that although PESCO had been developed by taking usability guidelines into account, there was room for improvement. Results from the second study indicated moderate concurrent validity between PESCO and standardized tests (Pearson’s r from .501 to .702) and highlighted the effectiveness of training exercises for improving attention (F = -4.111, p < .001) and planning (F = 5.791, p < .001) functions.ConclusionsPESCO can be used by the elderly. The PESCO cognitive test module demonstrated its concurrent validity with traditional cognitive evaluation tests. The stimulation module is effective for improving attention and planning skills.

Planning deficits in polysubstance dependent users: Differential associations with severity of drug use and intelligence

BACKGROUND Polysubstance use is associated with alterations in different components of executive functioning such as working memory and response inhibition. Nevertheless, less attention has been given to executive planning skills, which are required to benefit of low structured interventions. This study examines the association between severity of use of cocaine, heroin, alcohol, fluid and crystallized intelligence and planning tasks varying on degree of structure. METHODS Data were collected from 60 polysubstance users and 30 healthy controls. Cognitive assessment consisted of three planning tasks with different structure levels: Stockings of Cambridge, Zoo Map test, and Multiple Errands Test. RESULTS Polysubstance users had significant planning deficits across the three tasks compared to healthy controls. Hierarchical regression models showed that severity of drug use and fluid and crystallized intelligence significantly explained performance in all the planning tasks. However, these associations were higher for low-structured real world tasks. These low-structured tasks also showed a unique association with crystallized but not fluid intelligence. CONCLUSION Drug abuse is negatively associated with planning abilities, and intelligence is positively associated with planning performance in real-world tasks.

Preliminary validation of the Spanish version of the Frontal Systems Behavior Scale (FrSBe) using Rasch analysis

Primary objective: To explore the construct validity of the Spanish version of the Frontal Systems Behavioral Scale (FrSBe) using Rasch modelling. Methods: Item responses of 245 Spanish subjects were analysed using Rasch analysis: self-rating of 65 participants with TBI or stroke (sample A), family-rating of the same 65 participants (sample B) and self-rating of 115 healthy individuals (sample C). Results: After removing or grouping several problematic items, the Apathy and the Executive Dysfunction sub-scales were found to be valid measures for samples A and B and the Disinhibition sub-scale was valid for samples B and C. Person Separation Index of reliability of sub-scales was greater than 0.83 for sample B and ∼0.72 for A and C. All items showed disordered threshold categories in samples A and B and five items were ordered in sample C. Conclusions: With a few modifications, the sub-scales of the FrSBe-Spanish version are adequate measures for the assessment of the behavioural syndromes derived from frontal systems dysfunction in persons with brain injury. The family-rating form is preferable to the self-rating form. Only the Disinhibition scale is a valid measure for the behavioural assessment of the normal population. A reduction of response categories is suggested.

Family needs after brain injury: A cross cultural study

OBJECTIVE The objective of this study was to explore differences by country in the importance of family needs after traumatic brain injury (TBI), as well as differences in met/unmet needs. METHOD Two hundred and seventy-one family members of an individual with TBI in Mexico, Colombia, Spain, Denmark, and Norway completed the Family Needs Questionnaire. RESULTS Eight of the ten needs rated as most important globally were from the Health Information subscale. Importance ratings on the Health Information, Professional Support, and Involvement With Care subscales were similar across countries, but Mexican family members rated Instrumental Support needs as less important than Colombian, Spanish, and Danish family members, and also rated their Community Support needs as less important than Danish and Spanish family members. Mexican family members rated emotional support needs as less important than Colombian, Spanish, and Danish family members. Globally, the needs rated as most often met were from the Health Information subscale, and the most unmet needs were from the Emotional Support subscale. CONCLUSION Despite some similarities across countries several differences were identified, and these can help professionals to provide more culturally appropriate rehabilitation services for family members in order to improve informal care for TBI.

A pilot investigation of the potential for incorporating lifelog technology into executive function rehabilitation for enhanced transfer of self-regulation skills to everyday life

ABSTRACT The objective of the study was to identify the potential target and effect size of goal management training (GMT) enhanced with life-logging technology compared with standard GMT on a range of possible primary outcomes reflecting cognitive and ecological aspects of executive functioning and quality of life. Sixteen patients with acquired brain injury involving executive dysfunction were randomly allocated to one of the two interventions: seven weeks of GMT (n = 8), or seven weeks of GMT+Lifelog (n = 8). Outcome measures included a battery of executive function tests, the Dysexecutive Questionnaire (DEX) and the Quality of Life after Brain Injury scale (QOLIBRI), measured pre- and post-interventions. Within-group changes were assessed with related-samples t-tests and estimation of effect sizes. GMT+Lifelog was associated with significant changes, of medium to large effect size, in response inhibition (Stroop), multitasking (Strategy Application and Multiple Errand tests), DEX Intentionality and Positive Affect subscales and QOLIBRI Daily Life and Autonomy, subscales. GMT alone was associated with significant changes of overall quality of life. It was concluded that GMT+Lifelog holds promise to optimise the impact of GMT on executive dysfunction and quality of life.

Brief Moral Decision-Making Questionnaire: A Rasch-derived short form of the Greene dilemmas.

In this study, we developed the Brief Moral Decision-Making Questionnaire (BrMoD) as a standardized brief form of the dilemmas compiled by Greene and colleagues (Greene, Sommerville, Nystrom, Darley, & Cohen, 2001). An initial Rasch analysis was conducted over responses to 60 dilemmas to retain the most appropriate items. The psychometric properties of the 32-item brief instrument were determined in a community sample of 133 individuals using analyses from both the Rasch model and the classical test theory. The BrMoD scores showed appropriate reliability and construct validity. Differences between dilemma categories proposed by Greene et al. were observed in the BrMoD by measuring the difficulty of decisions and response times of the participants. In addition, there was no differential item functioning by the demographic variables. Therefore, the BrMoD is a good tool for assessing moral decision making in research or professional fields.