Using game authoring platforms to develop screen-based simulated functional assessments in persons with executive dysfunction following traumatic brain injury.

The assessment of functional status is a critical component of clinical neuropsychological evaluations used for both diagnostic and therapeutic purposes in patients with cognitive brain disorders. There are, however, no widely adopted neuropsychological tests that are both ecologically valid and easily administered in daily clinical practice. This discrepancy is a roadblock to the widespread adoption of functional assessments. In this paper, we propose a novel approach using a serious game authoring platform (eAdventure) for creating screen-based simulated functional assessments. We created a naturalistic functional task that consisted of preparing a cup of tea (SBS-COT) and applied the assessment in a convenience sample of eight dyads of therapists/patients with mild executive dysfunction after traumatic brain injury. We had three main aims. First, we performed a comprehensive review of executive function assessment in activities of daily living. Second, we were interested in measuring the feasibility of this technology with respect to staffing, economic and technical requirements. Third, a serious game was administered to patients to study the feasibility of this technology in the clinical context (pre-screening test). In addition, quantitative (Technology Acceptance Model (TAM) questionnaires) and qualitative (semistructured interviews) evaluations were applied to obtain user input. Our results suggest that the staffing, economic and technical requirements of the SBS-COT are feasible. The outcomes of the pre-screening test provide evidence that this technology is useful in the functional assessment of patients with executive dysfunction. In relation to subjective data, the TAM questionnaire showed good user acceptability from a professional perspective. Interview analyses with professionals and patients showed positive experiences related to the use of the SBS-COT. Our work indicates that the use of these types of authoring platforms could have positive long-term implications for neuropsychological research, opening the door to more reproducible, cooperative and efficient research by allowing the facilitated production, reuse and sharing of neuropsychological assessment tools.

The technology - activities of daily living questionnaire: a version with a technology-related subscale.

BACKGROUND: Information and communication technology (ICT) has become an increasingly important part of daily life. The ability to use technology is becoming essential for autonomous functioning in society. Current functional scales for patients with cognitive impairment do not evaluate the use of technology. The objective of this study was to develop and validate a new version of the Activities of Daily Living Questionnaire (ADLQ) that incorporates an ICT subscale. METHOD: A new technology-based subscale was incorporated into the Spanish version of the ADLQ (SV-ADLQ), entitled the Technology version of the ADLQ (T-ADLQ). The T-ADLQ was administered to 63 caregivers of dementia patients, 21 proxies of mild cognitive impairment patients and 44 proxies of normal elderly subjects (mean age of the sample ± SD: 73.5 ± 8.30 years). We analysed the convergent validity, internal consistency, reliability cut-off point, sensitivity and specificity of the T-ADLQ. The results of the T-ADLQ were compared to the SV-ADLQ. RESULTS: The T-ADLQ showed significant correlations with the Mini-Mental State Examination (MMSE), the Frontal Assessment Battery (FAB) as well as other measures of functional impairment and dementia severity (MMSE: r = -0.70; FAB: r = -0.65; Functional Assessment Questionnaire: r = 0.77; Instrumental Activities of Daily Living Scale: r = -0.75; Clinical Dementia Rating Scale: r = 0.72; p < 0.001). The T-ADLQ showed a good reliability with a relatively high Cronbach's α-coefficient (Cronbach's α = 0.861). When considering a functional impairment cut-off point greater than 29.25%, the sensitivity and specificity of the T-ADLQ were 82 and 90%, respectively. The area under the receiver-operating characteristic curve was 0.937 for the T-ADLQ and 0.932 for the original version of the test. CONCLUSIONS: The T-ADLQ revealed adequate indicators of validity and reliability for the functional assessment of activities of daily living in dementia patients. However, the inclusion of technology items in the T-ADLQ did not improve the performance of the scale, which may reflect the lack of widespread use of technology by elderly individuals. Thus, although it appeared reasonable to add technology use questions to the ADLQ, our experience suggested that this has to be done cautiously, since the sensitivity of these additional items could vary in different populations. The T-ADLQ needs to be validated in a different population of dementia subjects.

[Prognostic heterogeneity of attention deficit/hyperactivity disorder in adults]. / Descomponiendo el síndrome de déficit atencional en el adulto: hacia un entendimiento de su heterogeneidad pronóstica.

Attention Deficit/Hyperactivity Disorder (ADHD) is a clinical syndrome characterized by an onset in early life. More than 65% of patients persist with manifestations of ADHD in adulthood. These symptoms may interfere in activities of daily-living, interpersonal relationships and professional and academic achievement. Nevertheless, the observation of an important group of adults with ADHD who do not show significant difficulties in the areas mentioned before puts into evidence the prognostic heterogeneity of this disorder. One of the current, most accepted explanations is the Double-Pathway Model: two double-dissociated deficits (Executive Disorders and Delayed-Reward Processing impairments) are involved in the genesis of ADHD, which explains the existence of different behavioral phenotypes. Moreover, personality traits like tenacity or perseverance are associated with higher levels of achievement in adults. On these grounds, we propose the hypothesis that the neurobiological correlate of tenacity/perseverance is a preserved Delayed-Reward Processing capacity, although further studies are needed to verify this idea.

The CUIDEME Study: determinants of burden in chilean primary caregivers of patients with dementia.

BACKGROUND: Caring for a person with dementia is associated with well-documented increases in burden and distress and decreases in mental health and wellbeing. Studies assessing burden in caregivers of patients with dementia and its determinants are scarce in Latin America. OBJECTIVE: The main objective of this study was to assess the extent and the determinants of burden in informal primary caregivers of patients with dementia in Chile. METHODS: A descriptive study was conducted using clinically validated scales to assess dementia characteristics and to measure caregiver variables. Family socio-demographic characteristics and functional status, patient functional dependency and behavioral disturbances, and caregiver psychiatric morbidity were analyzed as independent variables to determine caregiver burden. RESULTS: Two hundred and ninety-two informal caregivers were included. There were more female (80%) than male caregivers, consisting mainly of daughters and spouses of the patients. Severe burden was reported in 63% of the caregivers, and 47% exhibited psychiatric morbidity. Burden was associated with caregiver psychiatric distress, family dysfunction, severity of neuropsychiatric symptoms and functional disability, but neither patient age, gender, nor socioeconomic status impacted burden. CONCLUSION: Our results underscore the importance of assessing the consequences of dementia in both caregivers and patients in order to evaluate the real biopsychosocial impact of dementia, as well as the importance of planning appropriate and effective public health interventions in Latin American countries. In addition, interventions targeting caregiver psychological distress, caregiver familial dysfunction, patient neuropsychiatric disorders, and patient functional disability could potentially diminish caregiver burden.

Descomponiendo el síndrome de déficit atencional en el adulto: hacia un entendimiento de su heterogeneidad pronóstica / Prognostic heterogeneity of attention deficit/hyperactivity disorder in adults

Attention Deficit/Hyperactivity Disorder (ADHD) is a clinical syndrome characterized by an onset in early life. More than 65% of patients persist with manifestations of ADHD in adulthood. These symptoms may interfere in activities of daily-living, interpersonal relationships and professional and academic achievement. Nevertheless, the observation of an important group of adults with ADHD who do not show significant difficulties in the areas mentioned before puts into evidence the prognostic heterogeneity of this disorder. One of the current, most accepted explanations is the Double-Pathway Model: two double-dissociated deficits (Executive Disorders and Delayed-Reward Processing impairments) are involved in the genesis of ADHD, which explains the existence of different behavioral phenotypes. Moreover, personality traits like tenacity or perseverance are associated with higher levels of achievement in adults. On these grounds, we propose the hypothesis that the neurobiological correlate of tenacity/perseverance is a preserved Delayed-Reward Processing capacity, although further studies are needed to verify this idea.