Impact of Educational Level on Versions (Basic and Complete) of the Montreal Cognitive Assessment.

BACKGROUND: One of the most marked problems in the use of screening instruments for the diagnosis of dementia or cognitive impairment in the elderly is the influence of educational level on the results of psychometric tests. The Montreal Cognitive Assessment (MoCA) questionnaire is one of the most widely used dementia screening instruments internationally and with greater proven validity. There is a version of this instrument called MoCA "Basic" which was developed to reduce education bias. The aim of the study was to compare the psychometric characteristics of the MoCA, full versus basic, versions in older adults. METHOD: Participants (N = 214) completed both versions of the MoCA, and screening measures to corroborate their health status. RESULTS: Internal consistency was satisfactory in both versions: MoCA full (0.79) and MoCA basic (0.76). The overall correlation between both tests was high (0.73). There was no relationship between the dimensions included in each version. Educational level and age explained 33.8% of the total variance in MoCA Full and 31.8% in MoCA Basic. Among educational levels, there are statistically significant differences in participants with <6 years of education. CONCLUSIONS: The results confirm that both versions are reliable instruments and also show that in both versions the educational level of <6 years of education continues to have an impact on performance. Therefore, it can be considered that the MoCA Basic version for the Ecuadorian population with <6 years of education continues to imply literacy competencies.

A Nationwide Study of Incidence and Mortality Due to Traumatic Brain Injury in Ecuador (2004-2016).

OBJECTIVE: Traumatic brain injury (TBI) is a public health problem worldwide. Information regarding TBI from low- and middle-income countries is scarce. The objectives of this study are to determine the incidence, mortality and geodemographic distribution of TBI in Ecuador. METHODS: A population-based analytical study from 2004 to 2016 was conducted in Ecuador. Men and women with a diagnosis of TBI from all ages (0-110 years) were included. Data was obtained from official hospital-discharges records and retrieved from the National Institute of Statistics and Census (INEC) Database. We analyzed data by region, province and canton with a monthly resolution. The incidence, mortality, case fatality rates and the risk of developing TBI within the population were calculated based on the last 13 years of available data. RESULTS: A total of 124,576 hospital admissions and 5,264 deaths due to TBI were registered in Ecuador from 2004 to 2016. The overall TBI-related hospital admission rate was 70.68 per 100,000. The sex- and age-specific rate was 90.1 per 100,000 for men and 64.1 per 100,000 for women. Mestizos' population has the highest adjusted incidence rate of 195.6 per 100,000, followed by the indigenous with 61.4 per 100,000 and Afro-Americans with 14.2 per 100,000. The overall annual mortality rate during the study ranged from 2.11 to 3.35 per 100,000. Case fatality rates were significantly higher in older populations, becoming fatal in up to 27% of men >90 years/old and in 15% of women older than 90 years/old. CONCLUSION: This is the first recorded epidemiological study of the socio-demographic distribution of TBI in Ecuador to date. The study found that young men were almost 4 times more likely to be hospitalized due to TBI than women of this age. Fatalities due to TBI were less likely to occur among younger age groups, increasing significantly among the elderly population. The national incidence rate of TBI has been decreasing since 2011, which coincides with the introduction of stricter alcohol regulation, suggesting that this measure might have played a role in this reduction.

Theory of Planned Behavior and alcohol use in adolescents in Ecuador. Structural linear regression analysis.

The general aim is to identify the explanatory potential of Alcohol use intentions in drinking behaviors in a sample of adolescents in Ecuador. The method consists of a descriptive, explanatory and cross-sectional study using SEM techniques. The participants were 384 adolescents (57% male and 43% female), aged among 14 and 18 years (M= 16.51; SD= 2.64), who are students attending between the 1st and 3rd year of high school in a public educational institution in Ambato, Ecuador. Like principal results, the presence of Alcohol use intention is moderate; the practice of alcohol use is low and mostly does not represent a risk, although 3.9% of the participants could report significant problems with consumption. Intentionality and drinking covary positively with low and moderate intensity. Drinking intentionality explained 15.3% the variance of drinking. We conclude that the Alcohol use intentions are a predictor of adolescent drinking behaviors.

Self-concept 6 months after traumatic brain injury and its relationship with emotional functioning.

This is an observational exploratory study assessing self-concept and its association with depression, anxiety, satisfaction with life, and quality of life 6 months after experiencing a traumatic brain injury. Participants were 33 patients who suffered a traumatic brain injury 6 months before the assessment. The measures used in this study were the Repertory Grid Technique, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Satisfaction With Life Scale, and the Quality of Life after Brain Injury. We calculated Euclidean distances to assess differences in pre-and post-injury self-perception, as well as the proportion of opposed pole construct rating and polarization to understand how they are associated with the scores of the other offered measures. We found that the distance between the present and ideal self, as well as the distance between the present self and the self before the lesion showed moderate positive correlations with depression, and negative correlations with satisfaction with life and quality of life. Also, for the present and self before the lesion, the proportion of opposed pole ratings was correlated with depression symptoms, quality, and satisfaction with life, while for the present self and the ideal self this proportion was correlated with all the measures. The proportion of polarization of the present self and the total polarization was negatively correlated with symptom measures. The repertory grid might facilitate a greater understanding of self-concept after traumatic brain injury. This information could be used to guide treatments that address the emotions related to distances observed in the perception of the self.

Psychological Distress in the Galapagos Islands During the COVID-19 Pandemic.

Objectives: to explore the emotional impact of the COVID-19 pandemic in the Galapagos Islands. Methods: an online survey of 369 participants, conducted on October of 2020, was used to assess levels of depression, anxiety, and stress, as well as specific behavioral and emotional reactions to the pandemic. Results: the prevalence of anxiety was 4% and depression 3.65%. Perceived stress level was higher, with 52% of the sample reporting moderate amounts. Women had higher levels of depression and perceived stress. Financial distress, interpersonal conflicts, feelings of isolation and fear of contagion of COVID-19 were all associated with higher levels of anxiety, depression, and stress. Conclusion: prevalence of anxiety and depression is lower in the Galápagos Islands during the pandemic compared to other regions, while stress levels are more significant and may warrant intervention. Despite being low, anxiety and depression were associated with potentially problematic behaviors and emotional reactions.

Normative data of neuropsychological tests of attention and executive functions in Ecuadorian adult population.

OBJECTIVE: The purpose of this study was to generate normative data for five tests of attention and executive functions (M-WCST, Stroop test, TMT, BTA, and SDMT), in a group of 322 Ecuadorian adults from Quito between the ages of 18 and 85. METHOD: Multiple regression analyzes taking into account age, education, and gender were used to generate the normative data. RESULTS: Age and education were significantly related to test performance such that scores decreased with age and improved as a function of education. An online calculator is provided to generate normative test scores. CONCLUSIONS: This is the first study that presents normative data for tests of executive functions and attention in an Ecuadorian adult population. This data will improve the clinical practice of neuropsychology and help to develop the field in the country.

Event-related potentials associated to N-back test performance in schizophrenia.

Mapping of Event-Related Potentials (ERP) associated with auditory and visual odd-ball paradigms has shown consistent differences between healthy controls and schizophrenia patients. It may be hypothesized that higher task attentional/cognitive demand will result in larger differences in these paradigms, which may help understanding the substrates of cognitive deficits in this syndrome. To this aim, we performed an EEG study comparing the effects of increasing the attentional/cognitive load of an auditory N-back task on the Event-Related Potential in 50 subjects with schizophrenia (11 first episodes) and 35 healthy controls. We considered a post-target window of 1000 ms to explore possible between groups differences in N100, P300, and Late Slow Wave (LSW), and compared these components between 0-back ('lower attentional/cognitive load) and 1-back ('higher attentional/cognitive load') conditions. Our results showed that N100 and LSW amplitude increase from 0- to 1-back condition was significantly larger in healthy controls compared to schizophrenia patients. Furthermore, LSW amplitude difference between 0- and 1-back conditions positively correlated with performance in the behavioral cognitive assessment. Taken together, these results support that higher task attentional/cognitive load (0-back vs. 1-back condition) increase N100 amplitude differences and reveal new findings related to the LSW component in schizophrenia.

Regression-Based Normative Data for Children From Latin America: Phonological Verbal Fluency Letters M, R, and P.

This study is part of a larger project to generate norms for letter verbal fluency test (VFT) in 3,284 children from nine Latin American countries. The letter VFT (letters M, R, and P) was administered and multiple linear regressions, including age, age2, MPE (mean parental education), MPE2, sex, and interactions were used as predictors. Results showed significant differences across countries for all scores. Age affected scores linearly except for Ecuador (P-letter), in which a quadratic effect was found. Scores increased linearly as a function of MPE, with the exception of Mexico (R-letter), in which a quadratic effect was found. Age by MPE (M- and P-letters), and age by MPE2 (R-letter) interactions were found in Mexico. Sex had an impact on letter R in Cuba, and letter P in Ecuador and Paraguay. Age2 by sex interaction was found in Ecuador (P-letter). These norms will be useful for clinical neuropsychologists in these countries to evaluate their patients' verbal fluency.

Search for schizophrenia and bipolar biotypes using functional network properties.

INTRODUCTION: Recent studies support the identification of valid subtypes within schizophrenia and bipolar disorder using cluster analysis. Our aim was to identify meaningful biotypes of psychosis based on network properties of the electroencephalogram. We hypothesized that these parameters would be more altered in a subgroup of patients also characterized by more severe deficits in other clinical, cognitive, and biological measurements. METHODS: A clustering analysis was performed using the electroencephalogram-based network parameters derived from graph-theory obtained during a P300 task of 137 schizophrenia (of them, 35 first episodes) and 46 bipolar patients. Both prestimulus and modulation of the electroencephalogram were included in the analysis. Demographic, clinical, cognitive, structural cerebral data, and the modulation of the spectral entropy of the electroencephalogram were compared between clusters. Data from 158 healthy controls were included for further comparisons. RESULTS: We identified two clusters of patients. One cluster presented higher prestimulus connectivity strength, clustering coefficient, path-length, and lower small-world index compared to controls. The modulation of clustering coefficient and path-length parameters was smaller in the former cluster, which also showed an altered structural connectivity network and a widespread cortical thinning. The other cluster of patients did not show significant differences with controls in the functional network properties. No significant differences were found between patients´ clusters in first episodes and bipolar proportions, symptoms scores, cognitive performance, or spectral entropy modulation. CONCLUSION: These data support the existence of a subgroup within psychosis with altered global properties of functional and structural connectivity.

Normative Data for Test of Verbal Fluency and Naming on Ecuadorian Adult Population.

Objective: To generate normative data for verbal fluency and naming test in an Ecuadorian adult population. Methods: The sample consisted of 322 healthy adults (18-84 years old) recruited from Quito, Ecuador. The verbal fluency and Boston Naming Test (BNT) were administered as part of a larger comprehensive neuropsychological battery. Multiple linear regression analyses were used to generate the normative data taking into account age, education, and sex. Results: For phonological verbal fluency, results indicated that only education was significantly related to the performance of the letters "A," "S," and "M." However, the performance on the letter "F" was significantly associated with age and education. For semantic fluency, the performance on "animals" was significantly influenced by age, quadratic age, and education, whereas that for "fruits" was explained by quadratic age, education, and sex. The performance on the BNT was significantly influenced by age and education. A Microsoft Excel-based calculator was created to help clinicians to obtain the normative data on this test. Conclusion: This normative data will help neuropsychologist in Ecuador to use these tests both in research and in their clinical practice to improve the diagnosis of cognitive deficits in the population.

Normative data for test of learning and memory in an ecuadorian adult population.

OBJECTIVE: The objective of this study was to develop norms for two neuropsychological tests of learning and memory in an Ecuadorian adult population. METHOD: 322 healthy individuals, ages between 18 and 84, were enrolled in the Metropolitan District of Quito. Participants were administered a comprehensive neuropsychological evaluation that included tests of learning and memory (Rey-Osterrieth Complex Figure Test [ROCF] and Hopkins Verbal Learning Test-Revised [HVLT-R]). Backward stepwise multiple linear regression analyses were used to examine the influence of demographic variables age, education, and gender on test performance. Normative data were developed adjusting for demographic variables found to be significant in the final regression models. RESULTS: The final multiple linear models revealed performance on tests of learning and memory worsened with age and improved as a function of education. A user-friendly Excel-based calculator is presented to calculate the z score and percentile automatically based on raw score and sociodemographic information. CONCLUSION: This is the first study that presents normative data for tests of learning and memory for an adult population in Ecuador. It is expected that these norms will help to improve the clinical practice of neuropsychology in Ecuador by limiting erroneous raw score interpretation and incrementing diagnostic accuracy.

Behavioral and sociodemographic predictors of anxiety and depression in patients under epidemiological surveillance for COVID-19 in Ecuador.

Ecuador has been one of the most affected countries by the Corona Virus Disease 19 (COVID-19) pandemic, by April 2020 this country presented the highest rates of mortality in Latin America. The purpose of the present study was to identify behaviors during confinement and sociodemographic variables associated with the mental health status of confirmed or suspected COVID-19 patients who were part of the epidemiological surveillance program in Ecuador that included mandatory confinement and self-isolation. A cross-sectional study was performed from March 22th to April 18th, 2020 using an online survey. The survey collected socio-demographic information and severity of depressive symptoms using the Patient Health Questionnaire-9 and anxiety symptoms through the Generalized Anxiety Disorder-7. A total of 759 patients completed the questionnaire, 20.3% presented moderate to severe symptoms of depression and 22.5% moderate to severe symptoms of anxiety. Being a woman and from the Coastal region were risk factors. Exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to an hour was associated with better mental health. Regression analysis indicated that the mentioned behaviors explained approximately 17% of the variance for depression sum scores and 11.8% of the variance for anxiety sum scores while controlling for gender and region. Understanding the association between sociodemographic variables and psychological states in patients with COVID-19 is relevant to tackle future public mental health problems and to implement health policies that are intended to palliate further psychiatric complications. Promotion of modifiable behaviors such as exercising, maintaining daily routines, and keeping informed about the COVID-19 but limiting to less than an hour is recommended.

Multivariate Base Rates of Low Scores on Tests of Learning and Memory among Spanish-Speaking Children.

To determine the prevalence of low scores on two neuropsychological tests commonly used to evaluate learning and memory in children. 6,030 healthy children from 10 countries in Latin America and Spain were administered Rey-Osterrieth Complex Figure (ROCF) and the Test de Aprendizaje y Memoria Verbal-Infantil (TAMV-I). Results showed that low scores are common when multiple neuropsychological outcomes (tests and/or scores) are evaluated in healthy individuals. Clinicians should consider the higher probability of low scores in a given individual when evaluating learning and memory using various sets of scores to reduce false-positive diagnoses of cognitive deficits in pediatric populations.

Subchronic use of rivastigmine increases procognitive flexibility across multimodal behavioral tasks in healthy male rats.

Rivastigmine (RVT) is a reversible inhibitor of cholinesterase approved worldwide for the treatment of cognitive dysfunctions, especially in Alzheimer's disease. Most previous pre-clinical studies have examined the effects of RVT treatment in a wide variety of pathological research models. Nonetheless, the effects of this drug on sensorimotor gating, memory, and learning tasks in healthy subjects remains unclear. In this study, we investigate the procognitive effects of RVT treatment in healthy rats through sensorimotor gating evaluations (measured as prepulse inhibition of the acoustic startle reflex), active avoidance learning, and spatial memory learning in a radial maze. There is an increase in the amplitude of the startle reflex in RVT-treated rats compared to the control groups, whereas the latency remained constant. Sensorimotor gating values were also incremented compared to those values from controls. In active avoidance, rats treated with RVT learned faster to successfully perform the task compared to controls, but afterwards all groups exhibited virtually identical results. During the sessions in the radial maze, RVT-treated rats committed fewer errors in both the working and reference memory compared to controls. All in all, our results support the hypothesis that RVT treatment may entail procognitive effects in healthy subjects.

[Relationship between subclinical psychotic symptoms and cognitive performance in the general population]. / Relaciones entre síntomas psicóticos subclínicos y rendimiento cognitivo en la población general.

INTRODUCTION: Subclinical psychotic symptoms are associated to negative life outcomes in the general population, but their relationship with cognitive performance is still not well understood. Assessing the relationship between performance in cognitive domains and subclinical psychotic symptoms in the general population may also help understand the handicap attributed to clinical psychosis, in which these alterations are present. METHODS: Subclinical and cognitive assessments were obtained in 203 participants from the general population by means of the Community Assessment of Psychic Experiences, the Brief Assessment of Cognition in Schizophrenia, the Wechsler Adults Intelligence Scale and the Wisconsin Card Sorting Test. The positive and negative subclinical symptoms and their relationship with age and cognition were examined, followed by assessing the influence of subclinical depression scores on the possible relationships between those subclinical psychotic symptoms and cognitive deficits. RESULTS: Inverse relationships were found between frequency in the Community Assessment of Psychic Experiences positive dimension and motor speed, and frequency and distress in the Community Assessment of Psychic Experiences negative dimension and motor speed. A direct relationship was also found between distress scores of the positive dimension and executive functions. Both positive and negative subclinical symptoms were related to depression scores. CONCLUSIONS: Psychotic symptoms, similar to those in the clinical population, may be associated with cognitive deficits in the general population.

Nivel educativo y la autonomía funcional en adultos que residen en Quito (Ecuador) / Educational level and functional autonomy in adults of Quito-Ecuador

Resumen La incapacidad funcional del adulto asociada al envejecimiento poblacional genera un problema de salud pública. El objetivo de este artículo es estudiar la asociación existente entre el nivel educativo y la autonomía funcional de los adultos del Distrito Metropolitano de Quito (DMQ) en Ecuador. Para ello se realizó un análisis secundario con la información de la base de datos del estudio "Montreal Cognitive Assessment (MoCA): datos normativos para la población ecuatoriana", que tiene un diseño transversal con adultos de 45 a 85 años. Se utilizó un modelo multivariado de regresión logística. El tamaño muestral fue de 328 participantes, de los cuales 301 fueron incluidos. Los resultados muestran diferencias significativas en cuanto al nivel educativo y la autonomía funcional: primero, permiten observar que un nivel educativo igual o mayor a los 12 años de instrucción es un factor de prevención de la pérdida de la autonomía funcional; segundo, muestran que hay una mayor posibilidad de pérdida de autonomía en función de la edad. Esta asociación existente entre el nivel educativo y la preservación de la autonomía funcional en el adulto en el DMQ muestra la importancia de promover el acceso a prácticas educativas permanentes en la población como parte de un programa de prevención de la pérdida de la autonomía mencionada.

Abstract The functional disability of the adult associated with population aging generates a public health problem due to the impact on the health and social care systems. The objective of this investigation was to study the association between educational level and functional autonomy of adults of the Metropolitan District of Quito (DMQ) in Ecuador. For this, a secondary analysis was done with the information from the database of the study "Montreal cognitive assesment (MOCA): normative data for the Ecuadorian population", the same one that has a cross-sectional study design with adults from 45 to 85 years old. A multivariate logistic regression model was used. The sample number was 328 participants of which 301 were included. The results show the significant differences in terms of educational level and functional autonomy, being a factor of prevention an educational level equal to or greater than 12 years of instruction. In addition, showing greater possibility of loss of autonomy based on age. This existing association between educational level and the preservation of functional autonomy in adults in the DMQ demonstrates the importance of promoting access to permanent educational practices in the population as part of a program to prevent the loss of functional autonomy.