A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions.

Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.

Standardization and diagnostic utility of the Frontal Assessment Battery for healthy people and patients with dementia in the Chilean population.

The Frontal Assessment Battery (FAB) is a screening test that measures executive functions. Although this instrument has been validated in several countries, its diagnostic utility in a Chilean population has not been studied yet. Objectives: This study aimed to (1) adapt FAB in a Chilean population; (2) study the psychometric properties of the FAB in a Chilean population; (3) assess the sociodemographic influence in the performance of the FAB in a sample of healthy controls (HC); and (4) develop normative data for this healthy group. Methods: A HC (n=344) and a group of patients with dementia (n=156) were assessed with the Chilean version of FAB. Results: FAB showed good internal consistency (Cronbach's alpha=0.79) and acceptable validity based on the relationship with other variables. Factor analysis showed the unidimensionality of the instrument. Significant differences were found in the total FAB value between the HC and dementia groups. With the matched sample, the established cutoff point was 13.5, showing a sensitivity of 80.8% and a specificity of 90.4%. Regression analysis showed that education and age significantly predicted FAB performance in the healthy group. Finally, normative data are provided. Conclusions: This study shows that FAB is a useful tool to discriminate between healthy people and people with dementia. However, further studies are needed to explore the capacity of the instrument to characterize the dysexecutive syndrome in people with dementia in the Chilean population.

A Bateria de Avaliação Frontal (FAB) é um teste de rastreio que mede as funções executivas. Embora esse instrumento tenha sido validado em vários países, sua utilidade diagnóstica em uma população chilena ainda não foi estudada. Objetivos: (1) Adaptar a FAB para uma população chilena; (2) estudar as propriedades psicométricas da FAB em uma população chilena; (3) avaliar a influência sociodemográfica no desempenho da FAB em uma amostra de controles saudáveis; e (4) desenvolver dados normativos para este último grupo. Métodos: Um grupo controle saudável (n=344) e um grupo de pacientes com demência (n=156) foram avaliados com a versão chilena da FAB. Resultados: A FAB apresentou boa consistência interna (alfa de Cronbach=0,79) e validade aceitável com base na relação com outras variáveis. A análise fatorial mostrou a unidimensionalidade do instrumento. Diferenças significativas foram encontradas no valor total da FAB entre os grupos controle saudável e demência. Com a amostra pareada, o ponto de corte estabelecido foi de 13,5, que apresentou sensibilidade de 80,8% e especificidade de 90,4%. A análise de regressão mostrou que a escolaridade e a idade predisseram significativamente o desempenho da FAB no grupo saudável. Finalmente, os dados normativos são fornecidos. Conclusões: O presente estudo mostrou que a FAB é uma ferramenta útil para discriminar entre pessoas saudáveis e aquelas com demência. No entanto, mais estudos são necessários para explorar a capacidade do instrumento para caracterizar a síndrome disexecutiva em pessoas com demência na população chilena.

Memory for future actions: the effect of prospective memory on an explicit and implicit memory task.

INTRODUCTION: In the field of retrospective memory, an explicit and implicit memory are known to exist. This study analyses the effect of the prospective memory on a recognition task and a lexical decision task. METHOD: In experiment 1 (n = 78, of which 39 belonged to the experimental group and 39 belonged to the control group), a recognition task was followed by an intentional task, as well as an incidental free recall task. In experiment 2 (n = 74, of which 37 belonged to the experimental group and 37 belonged to the control group), repetition priming was studied during a lexical decision task, followed by an intentional task. The data were analysed using a mixed ANOVA. RESULTS: Experiment 1 showed active monitoring of the prospective memory task accompanied by a recollective search process during the recognition task. The group which carried out the prospective task also showed better scores in the incidental free recall task. Experiment 2 showed active monitoring and repetition priming during the lexical decision task. CONCLUSION: While the prospective memory affects the performance in both concurrent tasks, it does not affect the recollective search process or repetition priming.

[Effectiveness of a mindfulness-based stress reduction program for family caregivers of people with dementia. Systematic review of randomised clinical trials]. / Eficacia del programa de reducción del estrés basado en mindfulness para cuidadores familiares de personas con demencia. Revisión sistemática de estudios clínicos aleatorizados.

Family caregivers of people with dementia usually have high levels of anxiety, depression, and overload symptoms, and are reasons for being considered a clinically vulnerable population. The objective of the present review is to examine the effectiveness of the mindfulness-based stress reduction program (MBSR) applied to this population. A search was made in the electronic databases for randomised trials with pre-post measurement in the last 15 years. The methodological quality was obtained using the Jadad scale. Finally, 5 articles were included, obtaining a sample of 309 participants. The score on the Jadad scale was 3.4 out of 5. In general, the MBSR program reduces anxiety and depression symptoms, as well as overload levels in the post-measurement. However, some studies showed a significant reduction in the psychological effects of the program during follow-up. More empirical studies are needed that can establish a more homogeneous protocol that reduces the ambiguity of some results.

[Cognitive neuroscience of aging: explanatory models]. / Neurociencia cognitiva del envejecimiento: modelos explicativos.

The aim of the cognitive neuroscience of aging is the study of brain activity and the cognitive processes associated with age. In order to understand the dynamics of neurocognitive activity in older people, the present review highlights four explanatory models. The first one (HAROLD) highlights brain bilaterality, mainly in the pre-frontal cortex. The second paradigm (PASA) places special emphasis on neuronal polarisation (anterior-posterior). The third model (CRUNCH) relates the manifest activity of the brain to the level of complexity of the task. The last one (ELSA) emphasises the spatial and temporal distribution of brain activity in the different phases of recovery. Although different in their content, the four explanatory models are perfectly compatible with the findings reported by neuroimaging techniques, suggesting the use of compensation strategies and cognitive reserve for interventions that may help to optimise the performance of older people.