Cognitive plasticity, cognitive functioning and quality of life (QoL) in a sample of young-old and old-old adults in southern Spain.

BACKGROUND AND AIMS: The present study was designed to assess the differences in cognitive plasticity, cognitive functioning and quality of life (QoL) in young-old and old-old adults, and to determine whether variables related to QoL can predict cognitive plasticity in old age. METHODS: The study population consisted of 215 people living in sheltered accommodation for elderly people in southern Spain. Participants were divided into two groups according to age: young-old aged (between 65 and 80 years) and old-old (81 and above). Participants were assessed by means of cognitive performance tests, a QoL questionnaire, and the auditory verbal learning test-learning potential (AVLT-LP) as a measure of cognitive plasticity. RESULTS: No significant differences were found in cognitive plasticity between the young-old and old-old adults, although the former performed better on immediate and sustained verbal recall. Likewise, no significant inter-group differences arose in most of the QoL variables. However, differences in cognitive plasticity did appear as a function of the level of cognitive functioning of the old adults, and cognitive functioning has been shown to be the best predictor of cognitive plasticity in old age. CONCLUSIONS: Differences in cognitive plasticity between young-old and old-old adults only appear when the cognitive functioning of individuals is taken into account, rather than their age group. The variables cognitive functioning, social integration and education level appear to be the best predictors of cognitive plasticity in old age.

[Sensitivity to pain, self-regulation, coping and personality in healthy adult women]. / Sensibilidad al dolor, autorregulación, afrontamiento y personalidad en mujeres adultas sanas.

The goals of this study were to investigate the relation between sensitivity to pain and subjectively perceived intensity of pain, and to establish which psychological variables affect lesser or greater objective sensitivity to experimental pain. The study sample consisted of 74 adult women without regular pain symptoms. Experimental pain was induced by means of the Portable Electronic Dolorimeter (DEP). Intensity of induced pain was evaluated using a Visual Analogic Scale (VAS). Psychological characteristics studied were self-government, stress-coping strategies, sensitivity to anxiety and the five personality dimensions evaluated by the BFQ of Caprara, Barbaranelli and Borgogni (1995). Results revealed a positive relation between sensitivity to pain and subjective intensity of pain. An analysis of variance also revealed statistically significant differences between groups with low and high sensitivity to pain in the following variables: self-motivation, focalization in problem-solving, positive reappraisal of stressful events, energy and mental openness. The importance of the study lies in the identification of specific psychological factors for intervention in the psychological treatment of pain.

[Memory lapses and memory: relationship between objective and subjective memory in old age]. / Olvidos y memoria: relaciones entre memoria objetiva y subjetiva en la vejez.

INTRODUCTION: research into memory in geriatrics and gerontology has become increasingly important in recent years. However, various studies have shown that not all aspects or types of memory are affected in the same way or with the same severity by old age. OBJECTIVES: the present study aimed to establish differential profiles in objective and subjective memory associated with old age with a view to establishing criteria that could be used to distinguish between age-associated memory loss and pathological memory loss, thus aiding diagnosis of cognitive impairment. MATERIAL AND METHODS: a total of 143 participants between 60 and 98 years of age were evaluated using a battery of tests comprising the validated Spanish version of the Mini-Mental State Examination [Lobo's Mini-Examen Cognoscitivo (MEC)], diverse tests for objective memory [the auditory verbal learning test of learning potential (AVLT-LP) and a working memory test], and the subjective memory questionnaire. RESULTS AND CONCLUSIONS: significant differences were found between distinct age groups in different measures of subjective and objective memory. In general terms, persons who complained most about memory problems were not those with poorer performance on objective memory tests. The results show that measures of subjective and objective memory assess different aspects of memory.

Hacia la creación de la especialidad sanitaria de Psicología Clínica de la Infancia y la Adolescencia / Towards the creation of the health qualification of Clinical Child and Adolescent Psychology

En España aún no existe un título oficial de especialista sanitario en Psicología Clínica de la Infancia y la Adolescencia, sin embargo, son muchos los argumentos que evidencian la necesidad de su creación. Entre los principales están la urgente necesidad de mejorar la calidad de la atención a la salud mental de la infancia y la adolescencia; el hecho de que esta especialidad sanitaria ya existe como rama científica diferenciada y consolidada; la necesidad de un programa de formación reglada propio para esta área de la psicología clínica, dada la especificidad y extensión de los conocimientos científicos y competencias profesionales necesarios para su ejercicio; o que la Psicología Clínica de la Infancia y la Adolescencia ya existe de facto como especialidad sanitaria diferenciada en algunos sistemas sanitarios públicos autonómicos. En este artículo se exponen y desarrollan estos y otros argumentos con el objetivo de impulsar la creación de esta nueva especialidad sanitaria en nuestro país. (AU)

There is still no official title of health specialist in Clinical child and adolescent psychology in Spain. However, there are many reasons for creating it: the urgent need to improve the quality of children and adolescents´ mental health care; the fact that this health specialty already exists as a differentiated and consolidated scientific discipline; the need for a proper training program for this clinical psychology area, due to the specificity and extent of the scientific knowledge and professional skills necessary for its exercise; or that Clinical child and adolescent psychology, as a matter of fact (although it is not yet officially or legally recognized), already exists as a differentiated health specialty in some public health systems. This article presents and explains these and other equally relevant reasons in detail, with the aim of promoting the creation of this new health specialty in our country. (AU)

[Prediction of cognitive impairment in the elderly by analysing their performance in verbal fluency and in sustained attention]. / Prediccion del deterioro cognitivo en ancianos mediante el analisis del rendimiento en fluidez verbal y en atencion sostenida.

INTRODUCTION: Cognitive decline is related to different kind of biopsychosocial variables in the elderly. AIM. To identify which cognitive variables are important to differentiate between healthy elderly people and elderly people with cognitive impairment in order to propose a brief screening assessment for cognitive impairment in which education is not relevant. SUBJECTS AND METHODS: 264 subjects were divided into two groups taking into account the cutoff point 23/24 in the MEC, and all of them were assessed in cognitive functioning, sustained attention, cognitive plasticity, working memory, and verbal fluency. RESULTS: Discriminant analysis showed that the cognitive variables which best explain cognitive impairment were verbal fluency, sustained attention and cognitive plasticity. The area under the ROC curve for the verbal fluency task was 0.811 and for the sustained attention task was 0.777. A cutoff point with 10 words in the verbal fluency task showed a sensitivity of 74% and a specificity of 80% for healthy elderly people, while a cutoff point with 33 correct answers in the sustained attention task showed a sensitivity of 68.4% and a specificity of 68.6% for the same group. CONCLUSIONS: These findings suggest that a high performance on verbal fluency and sustained attention protect against cognitive impairment in the elderly so that verbal fluency and sustained attention tasks are good tests for cognitive impairment screening purposes.

La fluidez verbal en personas mayores y su relación con variables psicosociales y de funcionamiento cognitivo / Verbal fluency in older people and its relationship with psychosocial variables and cognitive performance

Introducción: El análisis de la fluidez verbal en la vejez ha sido una de las principales estrategias como parte del diagnóstico de la demencia. Así, los estudios han demostrado que, en comparación con ancianos sanos, las personas con demencia muestran un deterioro significativo en fluidez verbal -especialmente en fluidez semántica- incluso después de controlar estadísticamente variables como la edad y el nivel educativo. Objetivo: El objetivo del estudio realizado es analizar la ejecución de personas mayores en una tarea de fluidez semántica y relacionarla con su rendimiento en otras tareas cognitivas (memoria de trabajo, atención y una prueba de screening), así como determinar la influencia de variables como el nivel educativo, la edad y el sexo en el rendimiento en la tarea de fluidez. Método: En el estudio han participado un total de 264 personas con una edad media de 79.57 años de la provincia de Granada. Los participantes han sido evaluados con una entrevista estructurada de variables psicosociales, una batería de evaluación neuropsicológica que incluye pruebas de fluidez, memoria, atención, y funcionamiento cognitivo general. Resultados: Los resultados muestran diferencias significativas en fluidez verbal en función del estatus cognitivo de las personas y del rango de edad. Igualmente se observan correlaciones significativas entre la fluidez y el resto de pruebas cognitivas aplicadas, siendo una prueba de screening cognitivo la que mejor predice la ejecución en fluidez. Conclusiones: Los datos obtenidos corroboran la importancia de la utilización de pruebas de fluidez en la evaluación psicológica de las personas mayores

Introduction: The analysis of verbal fluency in old age has been one of the main strategies as part of the diagnosis of dementia. Thus, studies have shown that, compared to healthy elderly people, those with dementia show a significant deterioration in verbal fluency -especially in semantic fluency- even after the statistical control of variables such as age and educational level. Objective: The objective of the study is to analyze the performance of older people in a task of semantic fluency and relate it to their performance in other cognitive tasks (working memory, attention task and a screening test) as well as to determine the influence of variables such as educational level, age and gender in the fluency task performance. Method: A total of 264 people with an average age of 79.57 years from the province of Granada participated in the study. Participants were evaluated with a structured interview of psychosocial variables, a battery of neuropsychological assessment that included tests of fluency, memory, attention, and general cognitive functioning. Results: The results showed significant differences in verbal fluency based on the cognitive status of the persons and the age range. Likewise, significant correlations were observed between fluency and the rest of past cognitive tests, the cognitive screening test being the best predictor of fluency performance. Conclusions: The data obtained corroborate the importance of the use of fluency tests in the psychological assessment of the elderly

Predicción del deterioro cognitivo en ancianos mediante el análisis del rendimiento en fluidez verbal y en atención sostenida / Prediction of cognitive impairment in the elderly by analysing their performance in verbal fluency and in sustained attention

Introducción. El deterioro cognitivo en el anciano se relaciona con diferentes variables biopsicosociales. Objetivo. Identificar qué variables cognitivas son relevantes a la hora de diferenciar ancianos sanos de ancianos con deterioro cognitivo, con el fin de proponer una evaluación de cribado breve no influida por el nivel educativo para la detección del deterioro cognitivo en la vejez. Sujetos y métodos. Se evaluaron 264 ancianos, de 65-96 años, en funcionamiento cognitivo general, atención sostenida, plasticidad cognitiva o potencial de aprendizaje, memoria de trabajo y fluidez verbal. Se establecieron dos grupos diferenciados, ancianos sanos y ancianos con deterioro cognitivo, a partir del corte de 24 puntos en el miniexamen cognitivo. Resultados. El análisis discriminante mostró que el mejor indicador del deterioro cognitivo fue el rendimiento en fluidez verbal semántica (FVS), seguido de la atención sostenida y el potencial de aprendizaje. Las tareas de FVS y atención sostenida mostraron unas áreas bajo las curvas ROC de 0,811 y 0,777, respectivamente. Para la FVS, un punto de corte de 10 palabras tuvo una sensibilidad para la discriminación de los ancianos sin deterioro del 74% y una especificidad del 80%, mientras que la atención sostenida mostró una sensibilidad del 68,4% y una especificidad del 68,6%. Conclusiones. El rendimiento en FVS y en atención sostenida parece ser un factor de protección frente al deterioro cognitivo en la vejez, con lo que podría utilizarse como prueba de cribado para la detección de ancianos con deterioro (AU)

Introduction. Cognitive decline is related to different kind of biopsychosocial variables in the elderly. Aim. To identify which cognitive variables are important to differentiate between healthy elderly people and elderly people with cognitive impairment in order to propose a brief screening assessment for cognitive impairment in which education is not relevant. Subjects and methods. 264 subjects were divided into two groups taking into account the cutoff point 23/24 in the MEC, and all of them were assessed in cognitive functioning, sustained attention, cognitive plasticity, working memory, and verbal fluency. Results. Discriminant analysis showed that the cognitive variables which best explain cognitive impairment were verbal fluency, sustained attention and cognitive plasticity. The area under the ROC curve for the verbal fluency task was 0.811 and for the sustained attention task was 0.777. A cutoff point with 10 words in the verbal fluency task showed a sensitivity of 74% and a specificity of 80% for healthy elderly people, while a cutoff point with 33 correct answers in the sustained attention task showed a sensitivity of 68.4% and a specificity of 68.6% for the same group. Conclusions. These findings suggest that a high performance on verbal fluency and sustained attention protect against cognitive impairment in the elderly so that verbal fluency and sustained attention tasks are good tests for cognitive impairment screening purposes (AU)

Intervenciones psicológicas eficaces para el tratamiento del trastorno límite de la personalidad / Effective Psychological Therapies for the Treatment of Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious psychiatric disorder in which people suffer from emotional instability, severe emotional distress and behavioral difficulties regarding both the relationship they have with themselves and with others. Attempted suicides are common. There is a lot of research about the effectiveness of therapies for this mental disorder. The aim of this review is to show the main empirical studies about psychological interventions for the treatment of BPD. Systematic reviews and clinical trials point to the dialectical-behavior therapy as being the best psychotherapeutic practice for the treatment of people with borderline personality disorder, due to the fact that it can reduce risk of suicide as well as substance abuse. It is thought that cognitive-behavioral therapy might also be an useful approach, although there is less evidence for this; cognitive treatments have not yet shown their effectiveness. Finally, there is evidence that some drugs could significantly improve the therapeutic effects of the psychological treatments used on patients suffering from this disorder (AU)

El trastorno límite de la personalidad (TLP) se caracteriza por la inestabilidad emocional y las dificultades en la relación con uno mismo y con los demás, siendo habituales los intentos serios de suicidio. El objetivo del presente trabajo es ofrecer una revisión actualizada sobre las intervenciones psicológicas con mayor evidencia científica en el tratamiento del TLP. Se consideraron los trabajos procedentes de revisiones sistemáticas y de ensayos clínicos aleatorizados recientes. La evidencia científica sugiere la terapia dialéctico-conductual como la opción terapéutica con mayor apoyo empírico, especialmente por su eficacia sobre la reducción de los intentos de autolisis y el consumo de sustancias. Existe también apoyo empírico, aunque con menor grado de evidencia, para la terapia cognitivo-conductual. Las intervenciones de tipo cognitivo no han demostrado aun su efectividad. Por último, algunas intervenciones farmacológicas podrían mejorar significativamente los efectos terapéuticos de las intervenciones psicológicas en este grupo de pacientes (AU)

Tratamiento cognitivo-conductual de una paciente con agorafobia y trastorno de pánico / Cognitive - behavioral treatment of a patient with agoraphobia and disorder of panic

La agorafobia es un trastorno mental que se caracteriza por el temor a los lugares abiertos y a otros espacios relacionados, tales como las multitudes o situaciones en las que puede ser dificil escapar hacia un lugar seguro. El trastorno de pánico se carazteriza, en principio, porla presencia de crisis recurrentes de ansiedad grave no limitadas a ninguna situación particular. En el presente trabajo se presenta el caso de una mujer de 39 años diagnosticada de agorafobia con trastorno de pánico, que acude mensualmente a una sesión de terapia de 1 hora de duración. Se aplicó un tratamiento multicomponente de cárazter cognitivo-conductual. Las técnicas empleadas fueron la psicoeducación de las respuestas de ansiedad, la re-estructuración cognitiva de sus pensamientos disfuncionales y la exposición gradual en vivi con prevención de respuesta. Se muestrna los principales hallazgos conseguidos según los informes subjetivos de la paciente(AU)

Agoraphobia is a mental health problem which is characterized by the fear to several situations such as crowded places or situations in which people think it is difficult to leave in case of danger. Panic disorder includes mild recurrent episodes of sudden, unpredictable, intense fear accompanied by symptoms such as palpitations, chest pain and faintness anywhere. In thise report, there is a 39-year-old woman who met diagnostic criteria for agoraphobia and panic disorder of panic. She is coming to a Mental Helath Community Service where she receives cognitive-behavioral treatament forone hour weekly. Psychoeducation, in vivo gradual exposure and response prevention were included in managing of disorder. The main results based in subjetive information are pointed out(AU)

Sensibilidad al dolor, autorregulación, afrontamiento y personalidad en mujeres adultas sanas / Sensitivity to pain, self-regulation, coping and personality in healthy adult women

Los objetivos de este estudio han sido investigar la relación existente entre la sensibilidad al dolor y la intensidad percibida del dolor, y determinar qué variables psicológicas influyen en la sensibilidad al dolor experimental en una muestra de 74 mujeres adultas sin síntomas habituales de dolor. El dolor experimental fue inducido mediante el dolorímetro electrónico portátil (DEP)® y la intensidad de dolor producida fue evaluada mediante una escala visual analógica (EVA). Las características psicológicas estudiadas han sido autogobierno, estrategias para el afrontamiento del estrés, sensibilidad a la ansiedad y las cinco dimensiones de personalidad evaluadas por el BFQ de Caprara, Barbaranelli y Borgogni (1995). Los resultados indican una relación positiva entre sensibilidad al dolor e intensidad subjetiva de dolor, y el análisis de varianza realizado muestra además diferencias estadísticamente significativas entre los grupos bajo y alto en sensibilidad al dolor en las variables automotivación, focalización en la solución de problemas, reevaluación positiva de los acontecimientos estresantes, energía y apertura mental (AU)

The goals of this study were to investigate the relation between sensitivity to pain and subjectively perceived intensity of pain, and to establish which psychological variables affect lesser or greater objective sensitivity to experimental pain. The study sample consisted of 74 adult women without regular pain symptoms. Experimental pain was induced by means of the Portable Electronic Dolorimeter (Dolorímetro Electrónico Portátil: DEP)®. Intensity of induced pain was evaluated using a Visual Analogic Scale (VAS). Psychological characteristics studied were self-government, stress-coping strategies, sensitivity to anxiety and the five personality dimensions evaluated by the BFQ of Caprara, Barbaranelli and Borgogni (1995). Results revealed a positive relation between sensitivity to pain and subjective intensity of pain. An analysis of variance also revealed statistically significant differences between groups with low and high sensitivity to pain in the following variables: self-motivation, focalization in problem-solving, positive reappraisal of stressful events, energy and mental openness. The importance of the study lies in the identification of specific psychological factors for intervention in the psychological treatment of pain (AU)

Olvidos y memoria: relaciones entre memoria objetiva y subjetiva en la vejez / Memory lapses and memory: relationship between objective and subjective memory in old age

Introducción: la importancia del estudio de la memoria en geriatría y gerontología ha ido aumentando considerablemente en los últimos años. Sin embargo, diferentes trabajos han puesto de manifiesto que no todas las facetas ni tipos de memoria se ven afectados del mismo modo ni en el mismo grado por el envejecimiento. Objetivos: el trabajo que se presenta se dirige a establecer perfiles diferenciales en memoria asociados a la edad con el fin de fijar criterios que sirvan para diferenciar los olvidos o pérdidas de memoria que pueden deberse al envejecimiento con las pérdidas patológicas de memoria, de tal modo que se disponga de normas precisas de diagnóstico del deterioro cognitivo. Material y métodos: en esta investigación han participado 143 personas, de 60 a 98 años que han sido evaluadas con una batería formada por el Mini-Examen Cognoscitivo (MEC), diferentes pruebas de memoria objetiva, entre las que se encuentran tareas de memoria de trabajo y Auditory Verbal test-potencial de aprendizaje (AVLT-PA) y el cuestionario de quejas subjetivas de memoria. Resultados y conclusiones: en primer lugar, se han encontrado diferencias significativas entre los diferentes grupos de edad establecidos en las diferentes medidas de memoria subjetiva y objetiva utilizadas. En segundo lugar, en términos generales, las personas que más se quejan sobre sus problemas de memoria no fueron aquellas que mostraron un peor rendimiento en las pruebas de memoria objetiva, y por último, los resultados muestran que las medidas subjetivas de memoria y las medidas objetivas evalúan aspectos diferentes

Introduction: research into memory in geriatrics and gerontology has become increasingly important in recent years. However, various studies have shown that not all aspects or types of memory are affected in the same way or with the same severity by old age. Objectives: the present study aimed to establish differential profiles in objective and subjective memory associated with old age with a view to establishing criteria that could be used to distinguish between age-associated memory loss and pathological memory loss, thus aiding diagnosis of cognitive impairment. Material and methods: a total of 143 participants between 60 and 98 years of age were evaluated using a battery of tests comprising the validated Spanish version of the Mini-Mental State Examination [Lobo¿s Mini-Examen Cognoscitivo (MEC)], diverse tests for objective memory [the auditory verbal learning test of learning potential (AVLT-LP) and a working memory test], and the subjective memory questionnaire. Results and conclusions: significant differences were found between distinct age groups in different measures of subjective and objective memory. In general terms, persons who complained most about memory problems were not those with poorer performance on objective memory tests. The results show that measures of subjective and objective memory assess different aspects of memory (AU)