Assessment of the Financial Capacity in the Context of Normal and Pathological Cognitive Aging. Preliminary Analysis of the Portuguese Version of the Numerical Activities of Daily- Living- Financial (NADL-F).

Financial capacity (FC) is conceptualized as a dimension that encompasses a wide range of basic aptitudes and the capacity to judge and assess situations and make decisions according to one best interests. The Numerical Activities of Daily-Living-Financial (NADL-F) is an instrument of FC for clinical use developed in Italy. This study aims to perform a preliminary analysis on the psychometric characteristics of the Portuguese version of NADL-F. NADL-F as well as other neuropsychological instruments were administered to three groups: Healthy Control (n = 11); Mild Neurocognitive Disorder group (n = 19); Major Neurocognitive Disorder group (n = 19). NADL-F and its tasks were considered acceptable, showed good reliability for the entire sample (α = .808) and the majority of the domains correlated significantly with each other and with the total scale. Between group comparisons showed significant differences regarding all domains. Arithmetic, schooling and executive functioning accounted for 54.1% of the variance on the test. The Portuguese version of NADL-F proved to be an acceptable and valid instrument of assessing FC in the context of cognitive aging. NADL-F is an instrument that emulates real life financial situations, and it can be used in a second level of evidence in the clinical model of FC assessment.

Validation of the Portuguese version of Addenbrooke's Cognitive Examination III in mild cognitive impairment and dementia.

BACKGROUND: Cognitive assessment is central to the diagnosis of cognitive impairment and dementia, and it should be performed in all patients in the early stages of the disease. Recently, the 3rd version of Addenbrooke's Cognitive Examination (ACE-III) has been developed in order to improve the previous versions. OBJECTIVES: The aim of this study was to determine the psychometric properties of the Portuguese version of ACE-III, namely: reliability and discriminative validity (sensitivity and specificity) in the identification of mild cognitive impairment (MCI) and dementia, in comparison to other neuropsychological screening tests, as well as to establish its concurrent and divergent validity. MATERIAL AND METHODS: The study encompassed a sample of 90 participants distributed into 3 groups: Control (n = 30), MCI (n = 30) and Dementia (n = 30). In addition to ACE-III, Clinical Dementia Rating (CDR) and Montreal Cognitive Assessment (MoCA) were also used. RESULTS: The reliability of ACE-III was very good (α = 0.914). ACE-III significantly differentiated the 3 groups. The receiver operating characteristic (ROC) curves significantly favored ACE-III in comparison to another screening test - MoCA. ACE-III presented higher levels of sensitivity and specificity. Its total score correlated positively with the results on MoCA (ρ = 0.912; p < 0.001) and negatively with a depression scale (ρ = -0.505; p < 0.001). CONCLUSIONS: The Portuguese version of ACE-III has very good reliability and high diagnostic capacity in the context of MCI and dementia. ACE-III also holds concurrent and divergent validity.

Phototest for neurocognitive screening in multiple sclerosis.

Multiple Sclerosis (MS) is one of the most common neurological disorders. Cognitive dysfunction is considered a clinical marker of MS, where approximately half of patients with MS have cognitive impairment. OBJECTIVE: The Phototest (PT) is a brief cognitive test with high diagnostic sensitivity, accuracy and cost-effectiveness for detecting cognitive deterioration. Our aim was to test the utility of the PT as a neurocognitive screening instrument for MS. METHODS: The study enrolled 30 patients with different types of MS from an outpatient clinic as well as 19 healthy participants. In conjunction with the PT, the Montreal Cognitive Assessment (MoCA), Barthel Index (BI), Expanded Disability Status Scale (EDSS), and Fatigue Severity Scale (FSS) were administered. RESULTS: The MS group obtained significantly lower results on all domains of the PT, except for the naming task. The PT showed good concurrent validity with the MoCA. In direct comparison to the MoCA, PT showed a greater area under the curve and higher levels of sensitivity and specificity for MS neurocognitive impairments. A cut-off score of 31 on the Phototest was associated with sensitivity of 100% and specificity of 76.7%. CONCLUSION: The PT is a valid, specific, sensitive and brief test that is not dependent on motor functions. The instrument could be an option for neurocognitive screening in MS, especially in identifying cases for further neuropsychological assessment and intervention.

A Esclerose Múltipla (EM) é das doenças neurológicas mais comuns. A disfunção cognitiva consiste num marcador clínico da EM, cerca de metade dos pacientes apresentam comprometimento cognitivo. OBJETIVO: O Fototest (FT) é um teste breve, sensível, específico e com boa relação custo-eficácia na deteção de deterioração cognitiva. Pretendemos testar a validade do FT como um instrumento de screening neurocognitivo na EM. MÉTODOS: O estudo envolveu uma amostra de 30 doentes com diferentes tipos de EM de uma clínica de tratamento ambulatório e 19 participantes saudáveis. Em conjunto com o FT, foram aplicados o Montreal Cognitive Assessment (MoCA), o Índice de Barthel (IB), a Expanded Disability Status Scale (EDSS) e a Escala de Severidade de Fadiga (FSS). RESULTADOS: O grupo EM obteve resultados significativamente inferiores em todos os domínios do FT, excepto na tarefa de nomeação. O FT apresenta boa validade concorrente com o MoCa. Na comparação direta com o MoCa, o FT revelou uma área sob a curva superior e níveis de sensibilidade e especificidade para os défices cognitivos na EM superiores. Ao ponto de corte de 31 no FT correspondem valores de sensibilidade de 100% e especificidade de 76,7%. CONCLUSÃO: O FT é um teste válido, específico, sensível e breve, não dependente das funções motoras. Pode ser uma opção para o screening neurocognitivo na EM, especialmente na identificação de casos para posterior avaliação neuropsicológica e intervenção.

INECO frontal screening: an instrument to assess executive dysfunction in schizophrenia.

Although several brief sensitive screening tools are available to detect executive dysfunction, few have been developed to quickly assess executive functioning. The INECO Frontal Screening (IFS) is a brief tool which has proved be useful for the assessment of the executive functions in patients with dementia. The aim of this study was to explore whether the IFS is as sensitive and specific as the BADS, a battery designed to assess the dysexecutive syndrome, in schizophrenia. Our sample comprised a group of 34 schizophrenic patients (Mean age = 39.59, DP = 10.697) and 31 healthy controls (Mean age = 35.52, DP = 10.211). To all groups were administered the BADS, Wisconsin Card Sorting Test and IFS. The results suggest that schizophrenic patients performed significantly worse than the control group in all tests (p < .05). The IFS total score was 13.29 for the experimental group and 26.21 for the control group (p < .001). Considering a cut-off of 14 points, the IFS sensitivity was 100% and specificity 56% in detection of executive dysfunction in schizophrenia, compared with the BADS, that if we consider a cut-off of 11 points, was a sensitivity of 100% and a specificity of 50%. Thus, IFS is a brief, sensitive and specific tool for the detection of executive dysfunction in schizophrenia.

Phototest for neurocognitive screening in multiple sclerosis / O Fototest no rastreio neurocognitivo na Esclerose Múltipla

Multiple Sclerosis (MS) is one of the most common neurological disorders. Cognitive dysfunction is considered a clinical marker of MS, where approximately half of patients with MS have cognitive impairment. Objective : The Phototest (PT) is a brief cognitive test with high diagnostic sensitivity, accuracy and cost-effectiveness for detecting cognitive deterioration. Our aim was to test the utility of the PT as a neurocognitive screening instrument for MS. Methods : The study enrolled 30 patients with different types of MS from an outpatient clinic as well as 19 healthy participants. In conjunction with the PT, the Montreal Cognitive Assessment (MoCA), Barthel Index (BI), Expanded Disability Status Scale (EDSS), and Fatigue Severity Scale (FSS) were administered. Results : The MS group obtained significantly lower results on all domains of the PT, except for the naming task. The PT showed good concurrent validity with the MoCA. In direct comparison to the MoCA, PT showed a greater area under the curve and higher levels of sensitivity and specificity for MS neurocognitive impairments. A cut-off score of 31 on the Phototest was associated with sensitivity of 100% and specificity of 76.7%. Conclusion : The PT is a valid, specific, sensitive and brief test that is not dependent on motor functions. The instrument could be an option for neurocognitive screening in MS, especially in identifying cases for further neuropsychological assessment and intervention.

A Esclerose Múltipla (EM) é das doenças neurológicas mais comuns. A disfunção cognitiva consiste num marcador clínico da EM, cerca de metade dos pacientes apresentam comprometimento cognitivo. Objetivo : O Fototest (FT) é um teste breve, sensível, específico e com boa relação custo-eficácia na deteção de deterioração cognitiva. Pretendemos testar a validade do FT como um instrumento de screening neurocognitivo na EM. Métodos : O estudo envolveu uma amostra de 30 doentes com diferentes tipos de EM de uma clínica de tratamento ambulatório e 19 participantes saudáveis. Em conjunto com o FT, foram aplicados o Montreal Cognitive Assessment (MoCA), o Índice de Barthel (IB), a Expanded Disability Status Scale (EDSS) e a Escala de Severidade de Fadiga (FSS). Resultados : O grupo EM obteve resultados significativamente inferiores em todos os domínios do FT, excepto na tarefa de nomeação. O FT apresenta boa validade concorrente com o MoCa. Na comparação direta com o MoCa, o FT revelou uma área sob a curva superior e níveis de sensibilidade e especificidade para os défices cognitivos na EM superiores. Ao ponto de corte de 31 no FT correspondem valores de sensibilidade de 100% e especificidade de 76,7%. Conclusão : O FT é um teste válido, específico, sensível e breve, não dependente das funções motoras. Pode ser uma opção para o screening neurocognitivo na EM, especialmente na identificação de casos para posterior avaliação neuropsicológica e intervenção.

INECO frontal screening: um instrumento para avaliar as funções executivas na depressão / INECO frontal screening: a tool to assess executive functions in depression / INECO frontal screening: una herramienta para evaluar las funciones ejecutivas en la depresión

O comprometimento das funções executivas constitui um dos défices mais robustos na perturbação depressiva. Contudo, poucos instrumentos têm sido concebidos para avaliar de forma breve e específica as funções executivas na depressão. Este estudo objetiva avaliar as funções executivas em doentes com depressão, analisar a relação existente entre a gravidade da depressão e o desempenho do funcionamento executivo, e verificar a sensibilidade e especificidade do INECO Frontal Screening (IFS) comparativamente com a Behavioural Assessment of Dysexecutive Syndrome (BADS) na avaliação das funções executivas em doentes com depressão. 50 participantes com depressão (Média idades = 43.46, DP = 10.71) e 35 participantes pertencentes ao grupo de controlo (Média idades = 40.91, DP = 10.46), de ambos os géneros, foram avaliados através do IFS e da BADS. Os participantes com depressão apresentaram um funcionamento executivo deficitário comparativamente ao grupo de controlo tanto no IFS como na BADS e o aumento da gravidade da depressão fez-se acompanhar por um maior comprometimento do funcionamento executivo. O IFS demonstrou-se tão sensível e específico quanto a BADS na deteção da disfunção executiva em doentes com depressão. Este estudo sugere que o IFS é um instrumento breve, sensível e específico para avaliar as funções executivas na depressão.

The impairment of executive functions is one of the most robust deficits in depressive disorder. However, very few tools have been designed to assess briefly and specific executive functions in depression. This study aims to assess executive functions in patients with depression, examine the relationship between depression severity and performance of executive functioning, and verify the sensitivity and specificity of INECO Frontal Screening (IFS) compared with the Behavioural Assessment of Dysexecutive Syndrome (BADS) in the assessment of executive functions in patients with depression. 50 participants with depression (mean age = 43.46, SD = 10.71) and 35 participants in the control group (mean age = 40.91, SD = 10.46), of both genders, were evaluated by the IFS and the BADS. Participants with depression showed an executive functioning deficit compared to the control group in both the IFS and the BADS and the increasing severity of depression was accompanied by a greater impairment in executive functioning. IFS proved as sensitive and specific as the BADS in the detection of executive dysfunction in patients with depression. This study suggests that IFS is a brief, sensitive and specific tool to assess executive functions in depression.

El compromiso de las funciones ejecutivas constituye uno de los déficits más robustos en la depresión. Sin embargo, pocos instrumentos han sido concebidos para evaluar de forma breve y específica las funciones ejecutivas en la depresión. El Objetivo de este trabajo fue evaluar las funciones ejecutivas en enfermos con depresión, analizar la relación existente entre la gravedad de la depresión y el desempeño ejecutivo, y verificar la sensibilidad y especificidad del INECO Frontal Screening (IFS) comparativamente con la Behavioural Assessment of Dysexecutive Syndrome (BADS) en la evaluación de las funciones ejecutivas en enfermos con depresión. 50 participantes con depresión (Media edades = 43.46, DP = 10.71) y 35 participantes pertenecientes al grupo de control (Media edades = 40.91, DP = 10.46), de ambos géneros, fueron evaluados a través del IFS y de la BADS. Los participantes con depresión presentaron un funcionamiento ejecutivo deficitario comparativamente al grupo de control tanto en el IFS como en la BADS y el aumento de la gravedad de la depresión se hizo acompañar por un mayor compromiso del funcionamiento ejecutivo. El IFS se demostró tan sensible y específico cuanto la BADS en la detección de la disfunción ejecutiva en enfermos con depresión. Este estudio sugiere que el IFS es un instrumento breve, sensible y específico para evaluar las funciones ejecutivas en la depresión.

Coping, executive functioning, inhibitory control and decision-making in a sample of depressed suicidal patients

Introduction: Suicidal behavior has been associated with several risk factors, including depression, maladaptive coping, and neuropsychological dysfunction. This study aimed to evaluate coping orientations, executive functioning, attentional capabilities and decision-making in depressed suicidal patients. Methods: Two groups were selected: 32 depressed patients with history of suicide attempt and 30 depressed patients without history of suicide attempt. The Beck Depression Inventory and the COPE Inventory scales were applied, as well as the following neuropsychological tests: Wisconsin Card Sorting Test, Stroop Test, and a modified Iowa Gambling Task. Results: The results indicate a higher level of dysfunction in the executive functioning, mental control, and decision-making domains, and lower levels of orientation to active and reflective coping strategies, humor, and positive signification in the suicidal group. Conclusions: These results indicate that there are neuropsychological differences between depressed patients with and without history of suicide attempt, which may contribute significantly to the occurrence of suicidal behavior. However, the processes involved and the way they contribute to the phenomenon are aspects that still need further clarification.