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.

Memory for future actions: the effect of prospective memory on an explicit and implicit memory task / Recuerdo de acciones futuras: efecto de la memoria prospectiva en una tarea explícita e implícita de memoria

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

INTRODUCCIÓN: en el campo de la memoria retrospectiva se conoce la existencia de la memoria explícita e implícita. Este estudio analiza el efecto de la memoria prospectiva en una tarea de reconocimiento y una tarea de decisión léxica. MÉTODO: en el experimento 1 (n = 78, de los cuales 39 pertenecían al grupo experimental y 39 al grupo control) una tarea de reconocimiento fue seguida de una tarea intencional, así como de una tarea de recuerdo libre incidental. En el experimento 2 (n =74, de los cuales 37 pertenecían al grupo experimental y 37 al grupo control) se estudió el priming de repetición durante una tarea de decisión léxica, seguido de una tarea intencional. Los datos fueron analizados con un ANOVA mixto. RESULTADOS: el experimento 1 mostró una monitorización de la tarea de memoria prospectiva junto a procesos de búsqueda recolectiva durante la tarea de reconocimiento. Asimismo, el grupo que llevó a cabo la tarea prospectiva mostró mejores puntuaciones en la tarea de recuerdo libre incidental. El experimento 2 mostró monitorización y priming de repetición durante la tarea de decisión léxica. CONCLUSIÓN: mientras que la tarea de memoria prospectiva tiene un efecto sobre el desempeño en ambas tareas concurrentes, no afectó a los procesos de búsqueda recolectiva y priming de repetición

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

La neurociencia cognitiva del envejecimiento tiene como objeto de estudio la actividad cerebral y los procesos cognitivos asociados a la edad. Con el fin de comprender la dinámica de la actividad neurocognitiva en los adultos mayores, la presente revisión pone de relieve 4 modelos explicativos. El primero de ellos (HAROLD) resalta la bilateralidad cerebral, principalmente, en el córtex prefrontal. El segundo paradigma (PASA) hace especial hincapié en la polarización neuronal (anterior-posterior). El tercer modelo (CRUNCH) relaciona la actividad manifiesta del cerebro con el nivel de complejidad de la tarea. El último de ellos (ELSA) pone el acento en la distribución espacial y temporal de la actividad cerebral en las diferentes fases de la recuperación. Aunque diferentes en su contenido, los 4 modelos explicativos son perfectamente compatibles con los hallazgos reportados por las técnicas de neuroimagen, sugiriendo, de cara a la intervención, la utilización de estrategias de compensación y reserva cognitiva que ayuden a optimizar el rendimiento de los adultos mayores (AU)

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 (AU)

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

Los cuidadores familiares de personas con demencia suelen presentar altos niveles de sintomatología ansiosa, depresiva y sobrecarga, por lo que son considerados como una población clínicamente vulnerable. El objetivo de la presente revisión es examinar la eficacia del programa de reducción del estrés basado en mindfulness (MBSR) aplicado a esta población. Se recogieron aquellos estudios clínicos aleatorizados con medida pre-post procedentes de las bases de datos electrónicas de los últimos 15 años. La calidad metodológica se obtuvo mediante la escala de Jadad. Finalmente fueron incluidos 5 artículos, obteniendo una muestra de 309 participantes. La puntuación en la escala Jadad fue de 3,4 sobre 5. En líneas generales, el programa MBSR reduce la sintomatología ansiosa, depresiva, así como los niveles de sobrecarga en la medida post. Sin embargo, algunos trabajos mostraron una reducción significativa de los efectos psicológicos del programa durante el seguimiento. Son necesarios más estudios empíricos que puedan establecer un protocolo más homogéneo que reduzca la ambigüedad de algunos resultados

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

Neuropsicología de la memoria prospectiva basada en el evento / Neuropsychology of event-based prospective memory

Introducción. La memoria prospectiva es la capacidad para recordar las acciones que se han de ejecutar en el futuro. Diferentes investigaciones provenientes de la neuropsicología experimental intentan dilucidar los procesos neurocognitivos subyacentes a la memoria prospectiva basada en el evento, esto es, las acciones demoradas que tienen lugar en un contexto predeterminado, el cual asumiría el papel de clave externa y, por tanto, contribuiría al éxito en el recuerdo intencional. Desarrollo. Tomando como referencia el dinamismo y la flexibilidad de la teoría multiproceso, los principales hallazgos han subrayado que el recuerdo prospectivo está influido, entre otros factores, por el tipo de clave. Así, cuando la señal es focal, la persona tiende a confiar en los procesos de recuperación espontánea. Por otro lado, cuando la señal es no focal, suele haber una tendencia a la monitorización. De forma paralela, los estudios en neuropsicología experimental han distinguido que la corteza prefrontal anterior y la red frontoparietal dorsal participarían en los procesos de monitorización de la señal. Por otro lado, la red frontoparietal ventral intervendría en los procesos de recuperación automática. Se discute además el papel del lóbulo parietal y el lóbulo temporal medial en las tareas prospectivas. Conclusión. El presente trabajo aboga por que las dos vías de procesamiento (monitorizado y espontáneo) favorecen el éxito en el recuerdo de la acción intencional basada en el evento. No obstante, conviene tener muy en cuenta que el momento en el que la persona decide poner en marcha un tipo de procesamiento (u otro) está influido por el tipo de señal (AU)

Introduction. Prospective memory is the capacity to remember actions that are to be performed in the future. Different studies from experimental neuropsychology attempt to unravel the neurocognitive processes underlying event-based prospective memory, that is, delayed actions that take place in a predetermined context, which would play the role of an external cue and would therefore contribute to successful intentional recall. Development. Taking the dynamism and flexibility of multiprocess theory as a reference, the main findings have highlighted the fact that prospective memory is influenced by, among other factors, the type of cue. Thus, when the cue is focal, the person tends to rely on spontaneous retrieval. In contrast, when the cue is not focal, there is usually a tendency towards monitoring. In parallel to this, studies in experimental neuropsychology have determined that the anterior prefrontal cortex and the dorsal frontoparietal network would participate in the cue monitoring processes. Conversely, the ventral frontoparietal network would intervene in automatic retrieval processes. Moreover, the role of the parietal lobe and the medial temporal lobe in prospective tasks is discussed. Conclusion. This study defends the idea that both processing pathways (monitored and spontaneous) favour success in recalling the event-based intentional action. It must nevertheless be borne in mind that the moment a person decides to set one type of processing (or another) in motion it is influenced by the type of cue (AU)