Treatment-induced diabetes neuropathy: description of singular clinical signs to reach a prompt diagnosis.

A 23-year-old woman diagnosed with type 1 diabetes mellitus in 2011 came to our outpatient office because of an inability to walk correctly. She was under a basal bolus insulin regimen. In the summer of 2016, she experienced a rapid improvement in her glycaemic control. A few weeks later, she started to complain of a severe burning pain in the soles of her feet (pain score 10/10). Neither macrovascular nor microvascular complications were detected. The patient was forced to walk barefoot due to an intense pain using shoes or socks and used to soak her feet in water for several hours daily. She also developed severe intolerance to environmental heat, both indoors and outdoors. A diagnosis of treatment-induced diabetic neuropathy was made. The patient was admitted to a general ward to start pain therapy. After a 6-month course of different neuropathic pain drugs, the patient was able to walk autonomously again.

Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones, instant messaging and social networks using MULTICAGE-TIC. / Tecnologías de la Información y la Comunicación (TIC): abuso de Internet, videojuegos, teléfonos móviles, mensajería instantánea y redes sociales mediante el MULTICAGE-TIC.

Use/abuse of Information and Communications Technologies (ICT) has in recent years become a topic of great interest. Current discussion addresses whether it must be considered addictive behaviour and if it is a problem that primarily affects adolescents and youth. This study aims to understand the problems that affect people of all ages in controlling the use of these ICTs and whether they are related to mental health problems, stress and difficulties in executive control of behaviour. A survey was administered through social networks and email, using the MULTICAGE-ICT, a questionnaire that explores problems in the use of Internet, mobile phones, video games, instant messaging and social networks. Additionally, the Prefrontal Symptom Inventory, General Health Questionnaire and Perceived Stress Scale were administered. The sample was comprised of 1,276 individuals of all ages from different Spanish-speaking countries. The results indicate that about 50% of the sample, regardless of age or other variables, presents significant problems with the use of these technologies, and that these problems are directly related to symptoms of poor prefrontal functioning, stress and mental health problems. The results reveal the need for reconsidering whether we are facing an addictive behaviour or a new problem demanding environmental, psychological, sociological and sociopolitical explanations; therefore, it is necessary to reformulate actions to be implemented to address and refocus our understanding of the problem.

El uso/abuso de las Tecnologías de la Información y la Comunicación (TIC) es un tema que suscita enorme interés en los últimos años. Está en discusión si debe recibir la consideración de conducta adictiva y si es un problema que afecte prioritariamente a adolescentes y jóvenes. El presente estudio pretende conocer los problemas que afectan a las personas de todas las edades en el control del uso de estas TICs y si están relacionados con problemas de salud mental, estrés y dificultades en el control superior del comportamiento. Se realiza una encuesta a través de redes sociales y correo electrónico, en el que se administra el cuestionario MULTICAGE-TIC, que explora problemas en el uso de Internet, teléfono móvil, videojuegos, mensajería instantánea y redes sociales. Adicionalmente se administra el Inventario de Síntomas Prefrontales, el Cuestionario de Salud General y la Escala de Estrés Percibido. Se obtiene una muestra de 1.276 sujetos de todas las edades y diferentes países de habla hispana. Los resultados apuntan a que alrededor del 50% de la muestra presenta importantes problemas en el uso de estas tecnologías, y que esos problemas se relacionan directamente con síntomas de mal funcionamiento prefrontal, estrés y problemas de salud mental, independientemente de la edad u otras variables. Estos resultados sugieren reconsiderar si se trata de una patología adictiva o si estamos ante un problema novedoso que requiere de explicaciones de índole ambiental, psicológica, sociológica y sociopolítica, debiendo reformular las acciones a emprender para reorientar la comprensión y el abordaje del problema.

Tecnologías de la Información y la Comunicación (TIC): abuso de Internet, videojuegos, teléfonos móviles, mensajería instantánea y redes sociales mediante el MULTICAGE-TIC / Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones, instant messaging and social networks using MULTICAGE-TIC

El uso/abuso de las Tecnologías de la Información y la Comunicación (TIC) es un tema que suscita enorme interés en los últimos años. Está en discusión si debe recibir la consideración de conducta adictiva y si es un problema que afecte prioritariamente a adolescentes y jóvenes. El presente estudio pretende conocer los problemas que afectan a las personas de todas las edades en el control del uso de estas TICs y si están relacionados con problemas de salud mental, estrés y dificultades en el control superior del comportamiento. Se realiza una encuesta a través de redes sociales y correo electrónico, en el que se administra el cuestionario MULTICAGE-TIC, que explora problemas en el uso de Internet, teléfono móvil, videojuegos, mensajería instantánea y redes sociales. Adicionalmente se administra el Inventario de Síntomas Prefrontales, el Cuestionario de Salud General y la Escala de Estrés Percibido. Se obtiene una muestra de 1.276 sujetos de todas las edades y diferentes países de habla hispana. Los resultados apuntan a que alrededor del 50% de la muestra presenta importantes problemas en el uso de estas tecnologías, y que esos problemas se relacionan directamente con síntomas de mal funcionamiento prefrontal, estrés y problemas de salud mental, independientemente de la edad u otras variables. Estos resultados sugieren reconsiderar si se trata de una patología adictiva o si estamos ante un problema novedoso que requiere de explicaciones de índole ambiental, psicológica, sociológica y sociopolítica, debiendo reformular las acciones a emprender para reorientar la comprensión y el abordaje del problema

Use/abuse of Information and Communications Technologies (ICT) has in recent years become a topic of great interest. Current discussion addresses whether it must be considered addictive behaviour and if it is a problem that primarily affects adolescents and youth. This study aims to understand the problems that affect people of all ages in controlling the use of these ICTs and whether they are related to mental health problems, stress and difficulties in executive control of behaviour. A survey was administered through social networks and email, using the MULTICAGE-ICT, a questionnaire that explores problems in the use of Internet, mobile phones, video games, instant messaging and social networks. Additionally, the Prefrontal Symptom Inventory, General Health Questionnaire and Perceived Stress Scale were administered. The sample was comprised of 1,276 individuals of all ages from different Spanish-speaking countries. The results indicate that about 50% of the sample, regardless of age or other variables, presents significant problems with the use of these technologies, and that these problems are directly related to symptoms of poor prefrontal functioning, stress and mental health problems. The results reveal the need for reconsidering whether we are facing an addictive behaviour or a new problem demanding environmental, psychological, sociological and sociopolitical explanations; therefore, it is necessary to reformulate actions to be implemented to address and refocus our understanding of the problem

La "Escala de estrés percibido": estudio psicométrico sin restricciones en población no clínica y adictos a sustancias en tratamiento / The Perceived Stress Scale: an unrestricted approach to its psychometric properties in non-clinical population and treated substance-addicts

La "Escala de estrés percibido" (EEP) es uno de los autoinformes más utilizados en la actualidad para estimar el grado en que las personas sienten que controlan las circunstancias de la vida o se ven desbordadas por ellas. Se realizó un análisis factorial exploratorio sin restricciones sobre una muestra de participantes de población general (n= 1023) y un análisis confirmatorio en una muestra clínica de personas con adicción a drogas en tratamiento (n= 542). De las tres versiones de la EEP (14, 10 y 4 ítems), la de 10 ítems es la que presenta mejores propiedades psicométricas en ambas muestras. Los sujetos clínicos mostraron mayores niveles de estrés percibido, asociados con estrategias de afrontamiento pasivas (evitación) y con más sintomatología comportamental de origen prefrontal en la vida cotidiana. La EEP-10 presenta suficientes garantías psicométricas para su utilización tanto en población general como aplicada a muestras clínicas, permitiendo estimar una variable crucial en el estudio de aspectos relacionados con el estrés, como la disfunción prefrontal y las estrategias que se utilizan ante dificultades de la vida

The Perceived Stress Scale (PSS) is currently one of the most used selfreports to estimate the extent to which people feel that they control the challenges of life or are overwhelmed by them. An unrestricted exploratory factor analysis over a sample of participants from the general population (n= 1023) and a confirmatory analysis in a clinical sample of drug addicts in treatment (n= 542) were performed. From the three versions (14, 10 and 4 items), the results suggest that the 10-item version is the one has better psychometric fit indicators in both samples. Addicted people showed higher levels of perceived stress in all age groups, which was associated with passive coping strategies (avoidance) and higher levels of prefrontal behavioral symptoms in everyday life. In conclusion, the 10-item version of the PSS presents enough psychometric properties for its use in estimating the perceived stress, applied both to general population and clinical samples. Its use allows to estimate a crucial variable in the study of stress-related conditions such as prefrontal dysfunction and strategies that the people used to cope with the difficulties of life

Personalidad y cerebro: un encuentro inevitable / No disponible

La personalidad es un constructo que, hasta los últimos años, no había suscitado demasiado interés entre los neuropsicólogos. Sin embargo, durante la década pasada han proliferado los estudios interesados en buscar correlatos cerebrales, estructurales y funcionales de rasgos de personalidad propuestos por las distintas teorías, especialmente el modelo de los cinco grandes factores de personalidad. Se ha ido acumulando evidencia sobre el hecho de que los cinco rasgos se relacionan con localizaciones cerebrales concretas pudiendo, actualmente, trazar un mapa cerebral asociado a cada rasgo. Estudios más recientes relacionan a estos rasgos con la red cerebral por defecto, donde residiría el compendio de reglas implícitas de gestión (personalidad), que se iría formando durante la vida mediante mecanismos de "plasticidad dependiente de la experiencia". Estas propuestas suponen el umbral de un cambio de paradigma que puede llevar el estudio de los "trastornos mentales" al territorio de las alteraciones en la conectividad cerebral

Personality is a construct that, until recent years, had not aroused much interest among neurologists and neuropsychologists. However, during the past decade it have proliferated interest in studies pursuing brain structural and functional correlates of personality traits proposed by different theories, especially the Big Five model of personality. These studies have accumulated evidence about the five traits related to specific brain locations, allowing, at the present time, drawing a brain map associated with each trait. More recent studies relate these features with the brain default mode network, where he reside the compendium of implicit rules of management which we call personality. This will go forming along the life through mechanisms of "experience-dependent plasticity". These proposals represent the threshold of a paradigm shift which may lead the study of "mental disorders" to the territory of the alterations in brain connectivity, which is an immediate challenge for neuroscience

Source analysis of spontaneous magnetoencephalograpic activity in healthy aging and mild cognitive impairment: influence of apolipoprotein E polymorphism.

The apolipoprotein E (APOE) ε4 allele is a genetic risk factor for the development of late-onset Alzheimer's disease (AD), which affects cholinergic system functioning. The association between reduced cholinergic levels and increase of magnetoencephalographic (MEG) low-frequency has been used to explain spectral changes found in AD patients. However, the investigation in predementia stages is scarce. We obtained MEG recordings from 25 aged controls and 36 mild cognitive impairment (MCI) patients during a resting-state condition. According to their APOE genotype, MCIs and controls were subdivided in carriers and non-carriers of the ε4 allele. Sources of spectral variations in these groups were calculated through beamforming. MCI patients exhibited a significant increase of relative power within the low-frequency domain, accompanied by a power decrease within the high-frequency range. APOEε4 carriers showed an increased relative power in the 4.5-6.5 Hz frequency range over frontal lobes. The power increase observed in controls carrying ε4 was significantly higher as compared with MCI non-carriers, while MCI carriers exhibited the highest relative power within the 4.5-6.5 Hz range. Higher power values within the low-frequency ranges correlated with a poorer cognitive performance in MCIs and controls. Our investigation demonstrates that APOEε4 affects resting-state activity to an extent that makes it more proximate to the pattern observed in early stages of AD. Therefore, a combination of genetic and neurophysiological information might help to detect MCI patients at higher risk of conversion to AD, and asymptomatic subjects at higher risk of developing a manifest cognitive deterioration.

The Default Mode Network is functionally and structurally disrupted in amnestic mild cognitive impairment - a bimodal MEG-DTI study.

Over the past years, several studies on Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) have reported Default Mode Network (DMN) deficits. This network is attracting increasing interest in the AD community, as it seems to play an important role in cognitive functioning and in beta amyloid deposition. Attention has been particularly drawn to how different DMN regions are connected using functional or structural connectivity. To this end, most studies have used functional Magnetic Resonance Imaging (fMRI), Positron Emission Tomography (PET) or Diffusion Tensor Imaging (DTI). In this study we evaluated (1) functional connectivity from resting state magnetoencephalography (MEG) and (2) structural connectivity from DTI in 26 MCI patients and 31 age-matched controls. Compared to controls, the DMN in the MCI group was functionally disrupted in the alpha band, while no differences were found for delta, theta, beta and gamma frequency bands. In addition, structural disconnection could be assessed through a decreased fractional anisotropy along tracts connecting different DMN regions. This suggests that the DMN functional and anatomical disconnection could represent a core feature of MCI.

Relación de las quejas de memoria con el rendimiento de memoria, el estado de ánimo y variables sociodemográficas en adultos jóvenes / Relationship between memory complaints and memory performance, mood and sociodemographic variables in young adults

Introducción. Las consultas en neurología por quejas de memoria se han incrementado en los últimos años, tanto en mayores como en jóvenes. Se han realizado pocos estudios sobre las variables que influyen en las quejas en adultos jóvenes. Objetivo. Analizar en esta población la relación de las quejas con el rendimiento objetivo de memoria, con la depresión y la ansiedad, con la edad, el sexo y el nivel de estudios. Sujetos y métodos. Muestra de 582 individuos trabajadores sin deterioro cognitivo y edad de 2-64 años. Los materiales utilizados fueron listas de palabras y escenas de familia de la escala de memoria de Wechsler, tercera edición, cuestionario de fallos de memoria de la vida diaria (MFE), y escala de depresión y ansiedad de Goldberg. Resultados. No se encontró asociación estadísticamente significativa entre la valoración subjetiva de la memoria y el rendimiento objetivo inmediato o demorado, ni en la memoria visual ni en la verbal. La depresión y la ansiedad fueron las variables con mayor correlación con la puntuación global del MFE. En el análisis de regresión, las variables significativas fueron: la depresión, con el mayor tamaño de efecto, la edad, los estudios universitarios y el sexo. Conclusión. Las personas jóvenes que manifestaron más olvidos cotidianos no presentaron un rendimiento menor en las pruebas objetivas de memoria. Las variables más importantes que intervinieron en las quejas fueron la depresión y la ansiedad. Las personas más jóvenes, las que tenían estudios universitarios y los varones manifestaron menos quejas de memoria (AU)

Introduction. Neurological consultations due to memory complaints have increased in recent years in both older and younger people. Few investigations have studied the variables related to memory complaints in young adults. Aim. To analyze, in a sample of young adults, the relationship between memory complaints and objective memory performance, depressive and anxiety symptoms, age, sex and level of studies. Subjects and methods. The study included 582 healthy workers, without cognitive impairment, aged 22-64 years. Assessment: Word List and Family Scenes of Wechsler Memory Scale-III, Memory Failures of Everyday Questionnaire (MFE) and Goldberg Anxiety and Depression Scale. Results. We did not find any significant association between subjective assessment of memory and objective performance, both immediate and delayed in verbal and visual memory. Depression and anxiety had the highest correlation with MFE. The significant variables in the multiple regression analysis were: depression, with the largest effect size, age, college studies and sex. Conclusion. In young adults, those which had a greater perception of daily forgetfulness were not those with lesser memory performance. The most important variables involved in memory complaints were depression and anxiety. Younger people, people with college education and men reported less memory complaints (AU)

[Relationship between memory complaints and memory performance, mood and sociodemographic variables in young adults]. / Relacion de las quejas de memoria con el rendimiento de memoria, el estado de animo y variables sociodemograficas en adultos jovenes.

INTRODUCTION: Neurological consultations due to memory complaints have increased in recent years in both older and younger people. Few investigations have studied the variables related to memory complaints in young adults. AIM: To analyze, in a sample of young adults, the relationship between memory complaints and objective memory performance, depressive and anxiety symptoms, age, sex and level of studies. SUBJECTS AND METHODS: The study included 582 healthy workers, without cognitive impairment, aged 22-64 years. ASSESSMENT: Word List and Family Scenes of Wechsler Memory Scale-III, Memory Failures of Everyday Questionnaire (MFE) and Goldberg Anxiety and Depression Scale. RESULTS: We did not find any significant association between subjective assessment of memory and objective performance, both immediate and delayed in verbal and visual memory. Depression and anxiety had the highest correlation with MFE. The significant variables in the multiple regression analysis were: depression, with the largest effect size, age, college studies and sex. CONCLUSION: In young adults, those which had a greater perception of daily forgetfulness were not those with lesser memory performance. The most important variables involved in memory complaints were depression and anxiety. Younger people, people with college education and men reported less memory complaints.

TITLE: Relacion de las quejas de memoria con el rendimiento de memoria, el estado de animo y variables sociodemograficas en adultos jovenes.Introduccion. Las consultas en neurologia por quejas de memoria se han incrementado en los ultimos años, tanto en mayores como en jovenes. Se han realizado pocos estudios sobre las variables que influyen en las quejas en adultos jovenes. Objetivo. Analizar en esta poblacion la relacion de las quejas con el rendimiento objetivo de memoria, con la depresion y la ansiedad, con la edad, el sexo y el nivel de estudios. Sujetos y metodos. Muestra de 582 individuos trabajadores sin deterioro cognitivo y edad de 22-64 años. Los materiales utilizados fueron listas de palabras y escenas de familia de la escala de memoria de Wechsler, tercera edicion, cuestionario de fallos de memoria de la vida diaria (MFE), y escala de depresion y ansiedad de Goldberg. Resultados. No se encontro asociacion estadisticamente significativa entre la valoracion subjetiva de la memoria y el rendimiento objetivo inmediato o demorado, ni en la memoria visual ni en la verbal. La depresion y la ansiedad fueron las variables con mayor correlacion con la puntuacion global del MFE. En el analisis de regresion, las variables significativas fueron: la depresion, con el mayor tamaño de efecto, la edad, los estudios universitarios y el sexo. Conclusion. Las personas jovenes que manifestaron mas olvidos cotidianos no presentaron un rendimiento menor en las pruebas objetivas de memoria. Las variables mas importantes que intervinieron en las quejas fueron la depresion y la ansiedad. Las personas mas jovenes, las que tenian estudios universitarios y los varones manifestaron menos quejas de memoria.

[Prefrontal symptoms and personality disorders in substance abusers]. / Sintomatologia prefrontal y trastornos de la personalidad en adictos a sustancias.

INTRODUCTION: Neuroimaging findings associate personality traits and their disorders with an altered functioning of certain areas of the brain, especially in the frontal lobe. There is a need for instruments that can be applied in clinical practice to explore these relations based on their behavioural manifestations. PATIENTS AND METHODS: The sample was composed of 371 subjects with substance abuse/dependence. The Prefrontal Symptoms Inventory (PSI) and the Millon Clinical Multiaxial Inventory II (MCMI-II) were administered and diagnostic interviews were carried out to determine the existence of disorders affecting axis II (personality disorders). RESULTS: Criteria satisfying a diagnosis of some personality disorder were present in 43.9% of the sample. The results show a broad correlational pattern between the prefrontal symptoms scales and those of personality disorders. The variance in up to eight of the 13 scales of the MCMI-II is predicted in over 20%, based on the combination of scales from the PSI. The personality disorders diagnosed by means of a clinical interview present differential prefrontal symptomatological profiles that were consistent with what was expected. CONCLUSIONS: The results support the hypothesis of a relationship between the diagnosis of personality disorders and frontal malfunctioning, thus suggesting new lines for studying and approaching them in clinical practice. Such new paths could involve the use of cognitive rehabilitation to improve day-to-day functioning and modify the neurological substrates underlying personality disorders.

Cribado neurocognitivo en adictos a sustancias: la evaluación cognitiva de Montreal / Neurocognitive screening in substance addicts: the Montreal Cognitive Assessment

Introducción. La detección de alteraciones neurocognitivas en adictos permitiría la asignación de los sujetos con deterioro funcional a programas de rehabilitación cognitiva. La evaluación cognitiva de Montreal (MoCA) es una prueba de cribado que puede ser útil en este tipo de pacientes. Objetivo. Utilizar la MoCA con una muestra de sujetos con adicciones en tratamiento y comparar los resultados obtenidos con los baremos propuestos para población general, deterioro cognitivo leve y demencias tempranas, así como la validez concurrente con pruebas de ejecución global y su relación con variables sociodemográficas y relativas a la adicción. Pacientes y métodos. Se administraron la MoCA y la prueba de cribado de los niveles cognitivos de Allen-5 (ACLS-5) a una muestra de 79 pacientes con adicción que iniciaban tratamiento en un centro específico. Resultados. Sólo un 29,1% de los participantes presentó un rendimiento normal comparado con los baremos propuestos por los autores. El resto se situó en puntuaciones por debajo del punto de corte, mostrando muchos de ellos un rendimiento alarmantemente bajo, incluso comparado con los baremos para deterioro cognitivo leve y demencias tempranas. La MoCA mostró validez concurrente con la ACLS-5 y correlación con el nivel académico, pero no con variables relativas a la adicción. Conclusiones. La MoCA es una prueba rápida, sencilla de administrar y corregir, que permite detectar a los sujetos con un rendimiento cognitivo bajo mínimos que requieren intervenciones neuropsicológicas y ocupacionales para la rehabilitación cognitiva, que incremente la adhesión al tratamiento y el aprovechamiento de otras intervenciones con importantes demandas cognitivas, como la psicoterapia de prevención de recaídas (AU)

Introduction. The detection of neurocognitive disorders in addicts would allow subjects with functional impairment to be assigned to cognitive rehabilitation programmes. The Montreal Cognitive Assessment (MoCA) is a screening test that can be a valuable aid with this kind of patient. Aims. To use the MoCA with a sample of subjects with addictions who are receiving treatment and to compare the results with the criteria proposed for the general population, mild cognitive impairment and early dementias. It also intends to examine the concurrent validity with global execution tests and the relationship with socio-demographic variables and others related to addiction. Patients and methods. The MoCA and the Allen Cognitive Level Screen-5 (ACLS-5) test were administered to a sample of 79 patients with addiction who were beginning treatment in a specific centre. Results. Only 29.1% of the participants presented normal performance in terms of the criteria proposed by the authors. The others achieved scores below the cut-off point, many of them displaying an alarmingly low score, even when compared with criteria for mild cognitive impairment and early dementias. The MoCA showed concurrent validity with the ACLS-5 and correlation with academic level, but not with variables related to addiction. Conclusions. The MoCA is a test that is quick and simple to administer and correct. It allows the detection of subjects with extremely low cognitive performance that require neuropsychological and occupational interventions for cognitive rehabilitation, which increases treatment compliance and the benefits to be gained from other interventions with important cognitive demands, such as relapse prevention psychotherapy (AU)

Sintomatología prefrontal y trastornos de la personalidad en adictos a sustancias / Prefrontal symptoms and personality disorders in substance abusers

Introducción. Los hallazgos de neuroimagen asocian los rasgos de la personalidad y sus trastornos al funcionamiento alterado de determinadas localizaciones cerebrales, especialmente en el lóbulo frontal. Se requieren instrumentos aplicables en la clínica que exploren estas relaciones a partir de sus manifestaciones comportamentales. Pacientes y métodos. La muestra estuvo compuesta por 371 sujetos con abuso/dependencia de sustancias. Se administraron el inventario de síntomas prefrontales (ISP) y el inventario clínico multiaxial de Millon-II (MCMI-II), y se realizaron entrevistas diagnósticas para estimar la existencia de trastornos del eje II (trastornos de la personalidad). Resultados. El 43,9% presentó criterios para el diagnóstico de algún trastorno de la personalidad. Los resultados muestran un amplio patrón correlacional entre las escalas de síntomas prefrontales y las de trastornos de la personalidad. La varianza de hasta ocho de las 13 escalas del MCMI-II se predice en más de un 20% a partir de la combinación de escalas del ISP. Los trastornos de la personalidad diagnosticados mediante entrevista clínica presentan perfiles de sintomatología prefrontal diferenciales y congruentes con lo esperado. Conclusiones. Los resultados sostienen la hipótesis de la relación entre el diagnóstico de trastornos de la personalidad y mal funcionamiento frontal, sugiriendo nuevas vías para su estudio y abordaje en la clínica, como el uso de la rehabilitación cognitiva para mejorar el funcionamiento cotidiano y modificar los sustratos neurológicos de los trastornos de la personalidad(AU)

Introduction. Neuroimaging findings associate personality traits and their disorders with an altered functioning of certain areas of the brain, especially in the frontal lobe. There is a need for instruments that can be applied in clinical practice to explore these relations based on their behavioural manifestations. Patients and methods. The sample was composed of 371 subjects with substance abuse/dependence. The Prefrontal Symptoms Inventory (PSI) and the Millon Clinical Multiaxial Inventory II (MCMI-II) were administered and diagnostic interviews were carried out to determine the existence of disorders affecting axis II (personality disorders). Results. Criteria satisfying a diagnosis of some personality disorder were present in 43.9% of the sample. The results show a broad correlational pattern between the prefrontal symptoms scales and those of personality disorders. The variance in up to eight of the 13 scales of the MCMI-II is predicted in over 20%, based on the combination of scales from the PSI. The personality disorders diagnosed by means of a clinical interview present differential prefrontal symptomatological profiles that were consistent with what was expected. Conclusions. The results support the hypothesis of a relationship between the diagnosis of personality disorders and frontal malfunctioning, thus suggesting new lines for studying and approaching them in clinical practice. Such new paths could involve the use of cognitive rehabilitation to improve day-to-day functioning and modify the neurological substrates underlying personality disorders(AU)

Nueva versión reducida del test de denominación de Boston para mayores de 65 años: aproximación desde la teoría de respuesta al ítem / A new shortened version of the Boston Naming Test for those aged over 65: an approach from item response theory

Introducción. Uno de los tests más utilizados para la evaluación de la afasia en la práctica clínica es el test de denominación de Boston (BNT), una prueba clásica en la que se presentan 60 láminas con dibujos en blanco y negro que valoran la capacidad de los sujetos para denominar dichos dibujos. Pese a su bondad psicométrica, resulta necesario reducir el número de ítems de la prueba con el fin de disminuir su tiempo de aplicación. Sujetos y métodos. Se reclutó una muestra de 547 sujetos mayores de 65 años a los que se les aplicó un protocolo de evaluación neuropsicológica, que incluía el BNT, para determinar sus estados cognitivos; 405 sujetos no presentaron alteraciones cognitivas relevantes, frente a 142 sujetos que fueron diagnosticados de deterioro cognitivo leve. Resultados. La reducción del número de ítems se realizó de acuerdo con los supuestos de la teoría de respuesta al ítem. Puesto que tanto la edad como el nivel educativo mostraron un efecto significativo en el rendimiento de la prueba, ambas variables fueron utilizadas para hallar los puntos de corte de la nueva versión reducida. Ésta presentó una adecuada fiabilidad (alfa = 0,765) y una elevada correlación con la prueba original (r = 0,876). Conclusiones. La nueva versión reducida consta de 15 ítems ordenados en función de su dificultad. Se trata de una tarea con un elevado poder discriminativo de utilidad en la clínica diaria para la detección de alteraciones del lenguaje en personas mayores (AU)

Introduction. One of the tests that is mostly widely used to evaluate aphasia in clinical practice is the Boston Naming Test (BNT), a classic test in which 60 black and white pictures are presented to subjects in order to evaluate their capacity to put a name to such pictures. Despite its psychometric goodness, the number of items in the test has to be reduced in order to lower the time required to apply it. Subjects and methods. Researchers recruited a sample of 547 subjects over the age of 65, who were then administered a neuropsychological evaluation protocol, including the BNT, to determine their cognitive statuses. No relevant cognitive alterations were observed in 405 subjects versus 142 who were diagnosed with mild cognitive impairment. Results. The number of items was reduced in accordance with the premises of the item response theory. Since both age and level of schooling were found to have a significant effect on performance in the test, the two variables were used to find the cut-off points of the shortened version. This new version presented an adequate degree of reliability (alpha = 0.765) and a high correlation with the original test (r = 0.876). Conclusions. The new shortened version consists of 15 items that are ordered according to the degree of difficulty. It is a task with a high level of discriminating power that is useful in day-to-day clinical practice for detecting alterations in the anguage of the elderly (AU)

[A new shortened version of the Boston Naming Test for those aged over 65: an approach from item response theory]. / Nueva versión reducida del test de denominación de Boston para mayores de 65 años: aproximación desde la teoría de respuesta al ítem.

INTRODUCTION: One of the tests that is mostly widely used to evaluate aphasia in clinical practice is the Boston Naming Test (BNT), a classic test in which 60 black and white pictures are presented to subjects in order to evaluate their capacity to put a name to such pictures. Despite its psychometric goodness, the number of items in the test has to be reduced in order to lower the time required to apply it. SUBJECTS AND METHODS: Researchers recruited a sample of 547 subjects over the age of 65, who were then administered a neuropsychological evaluation protocol, including the BNT, to determine their cognitive statuses. No relevant cognitive alterations were observed in 405 subjects versus 142 who were diagnosed with mild cognitive impairment. RESULTS: The number of items was reduced in accordance with the premises of the item response theory. Since both age and level of schooling were found to have a significant effect on performance in the test, the two variables were used to find the cut-off points of the shortened version. This new version presented an adequate degree of reliability (alpha = 0.765) and a high correlation with the original test (r = 0.876). CONCLUSIONS: The new shortened version consists of 15 items that are ordered according to the degree of difficulty. It is a task with a high level of discriminating power that is useful in day-to-day clinical practice for detecting alterations in the language of the elderly.

Inventario de síntomas prefrontales para la evaluación clínica de las adicciones en la vida diaria: proceso de creación y propiedades psicométricas / Prefrontal Symptoms Inventory for clinical evaluation of addictions in everyday life: development process and psychometric properties

Introducción. La investigación evidencia la presencia de sintomatología prefrontal en los adictos, aunque en su valoraciónse suelen usar cuestionarios creados para el daño cerebral sobrevenido.Objetivo. Elaborar un instrumento específico para la evaluación de dicha sintomatología en sujetos con adicciones. Sujetos y métodos. Se reclutaron 1.624 participantes (445 adictos y 1.179 de población general) a los que se aplicó un inventariode 100 ítems basados en las tres esferas de la actividad humana (cognición, emoción y conducta) en relación con los tres grandes síndromes prefrontales (dorsolateral, ventromedial y orbital). Los análisis preliminares descartaron aquellos que no mostraron suficiente capacidad discriminante, configurando el inventario de síntomas prefrontales (ISP) de 46 ítems. Se administraron el cuestionario disejecutivo (DEX-Sp) y la escala de estrés percibido (EEP) para estudiar su validezconvergente. Resultados. Los datos muestran la estructura trifactorial del cuestionario: problemas en el control ejecutivo (con tressubfactores; problemas motivacionales, de control y atencionales), problemas en la conducta social y problemas en elcontrol emocional. Se analizan las relaciones entre las puntuaciones en el ISP con variables sociodemográficas y del consumo, así como con el DEX-Sp y la EEP. Se proporciona una versión reducida de 20 ítems como cribado. Conclusiones. El ISP relaciona la autoevaluación de las personas (‘sujetocéntrica’) con la formulación teórica a priori (‘cerebrocéntrica’), mostrando unas propiedades psicométricas adecuadas. Se propone su uso a la hora de explorar la sintomatología prefrontal de los adictos, así como en otras poblaciones clínicas o subclínicas con perfiles cognitivos similares (AU)

Introduction. Research has provided evidence of the presence of prefrontal symptoms in addicts, although they are usuallyevaluated using questionnaires that were created for acquired brain injury. Aims. To produce a specific instrument for evaluating those symptoms in subjects with addictions. Subjects and methods. For the study, 1624 participants were recruited (445 addicts and 1179 from the general population) and were given a 100-item inventory to complete based on the three spheres of human activity (cognition, emotion andbehaviour) in relation to the three great prefrontal syndromes (dorsolateral, ventromedial and orbital). The preliminaryanalyses ruled out those that did not prove to have sufficient discriminating power, which resulted in the Prefrontal Symptoms Inventory (PSI) consisting of 46 items. The Dysexecutive Questionnaire (DEX-Sp) and the Perceived Stress Scale (PSS) were administered in order to study the convergent validity. Results. The data show the three-factor structure of the questionnaire: problems with executive control (with three subfactors: problems with motivation, control and attention), problems with social behaviour and problems with emotional control. The relationships between the scores on the PSI and sociodemographic and consumption variables, as well as withthe DEX-Sp and the PSS were analysed. A reduced 20-item version is provided for screening. Conclusions. The PSI relates the (‘subject-centred’) self-evaluation of persons with the a priori (‘brain-centred’) theoretical formulation, the results showing adequate psychometric properties. We recommend its use when it comes to exploring the prefrontal symptoms of addicts, as well as other clinical or subclinical populations with similar cognitive profiles (AU)

Evaluación y diagnóstico del deterioro cognitivo leve / Evaluation and diagnosis of mild cognitive impairment

El deterioro cognitivo leve o ligero (DCL) es la disminución mantenida de las funciones cognitivas que no es suficientemente severa como para ser considerada una demencia. Actualmente el DCL está infradiagnosticado y el reto supone detectarlo en la fase prodrómica dado que es un proceso que con frecuencia evoluciona a la enfermedad de Alzheimer (EA). Los nuevos criterios de diagnóstico del DCL incluyen biomarcadores, pero, en la práctica diaria, la historia clínica y la evaluación de diversas esferas, sobre todo la neuropsicológica, siguen siendo las herramientas más eficaces. El paciente suele acudir a consulta con quejas de memoria aunque a veces es llevado por los familiares que observan olvidos importantes. El primer paso es detectar que haya deterioro cognitivo con pruebas de cribaje entre las que se encuentran el MMSE o el Test 7 Minutos. Para confirmar la sospecha se completa la evaluación por áreas, sobre todo la memoria, o empleando baterías especiales para deterioro cognitivo y/o demencia. Es preciso evaluar las capacidades funcionales mediante escalas de valoración de las actividades de la vida diaria y explorar los síntomas neurológicos y psiquiátricos. También se realizan pruebas complementarias para descartar posibles causas de deterioro cognitivo reversible. Un diagnóstico precoz del DCL nos permitirá poner en marcha cuanto antes terapias no farmacológicas y en breve, terapias farmacológicas, así como enlentecer el desarrollo del deterioro cognitivo (AU)

Mild cognitive impairment (MCI) is a sustained decrease of cognitive functions that is insufficiently severe to warrant a diagnosis of dementia. Currently, MCI is underdiagnosed. Since MCI often progresses to Alzheimer's disease, the challenge is to identify this process in the prodromal phase. New diagnostic criteria include the use of biomarkers. However, in daily practice, clinical history and the assessment of diverse areas, mainly neuropsychological, remain the most effective tools. The patient usually attends consultations with memory complaints, but is sometimes brought by relatives who observe substantial memory failures. The first step is to detect that there is cognitive impairment with screening tests such as the Mini Mental State Examination or the Seven Minute Test. To confirm suspicion, the evaluation is completed by assessing cognitive areas, especially memory, or by using specific batteries for cognitive deterioration and/or dementia. Complex functional tasks should be evaluated through scales of activities of daily living. Neurological and psychiatric symptoms should also be assessed. Additional studies (laboratory tests) are used to exclude reversible causes of cognitive impairment. Early diagnosis of MCI allows non-pharmacological therapies and, shortly, pharmacological treatments to be started as early as possible, thus slowing the development of cognitive deterioration (AU)

[Prefrontal Symptoms Inventory for clinical evaluation of addictions in everyday life: development process and psychometric properties]. / Inventario de sintomas prefrontales para la evaluación clinica de las adicciones en la vida diaria: proceso de creación y propiedades psicométricas.

INTRODUCTION: Research has provided evidence of the presence of prefrontal symptoms in addicts, although they are usually evaluated using questionnaires that were created for acquired brain injury. AIMS: To produce a specific instrument for evaluating those symptoms in subjects with addictions. SUBJECTS AND METHODS: For the study, 1624 participants were recruited (445 addicts and 1179 from the general population) and were given a 100-item inventory to complete based on the three spheres of human activity (cognition, emotion and behaviour) in relation to the three great prefrontal syndromes (dorsolateral, ventromedial and orbital). The preliminary analyses ruled out those that did not prove to have sufficient discriminating power, which resulted in the Prefrontal Symptoms Inventory (PSI) consisting of 46 items. The Dysexecutive Questionnaire (DEX-Sp) and the Perceived Stress Scale (PSS) were administered in order to study the convergent validity. RESULTS: The data show the three-factor structure of the questionnaire: problems with executive control (with three sub-factors: problems with motivation, control and attention), problems with social behaviour and problems with emotional control. The relationships between the scores on the PSI and sociodemographic and consumption variables, as well as with the DEX-Sp and the PSS were analysed. A reduced 20-item version is provided for screening. CONCLUSIONS: The PSI relates the ('subject-centred') self-evaluation of persons with the a priori ('brain-centred') theoretical formulation, the results showing adequate psychometric properties. We recommend its use when it comes to exploring the prefrontal symptoms of addicts, as well as other clinical or subclinical populations with similar cognitive profiles.

[Neuropsychological characterization of functional and dysfunctional impulsivity in drug addicts: clinical implications]. / Caracterización neuropsicológica de la impulsividad funcional y disfuncional en adictos a sustancias: implicaciones clínicas.

Impulsivity is a stable correlate throughout the course of drug addiction. However, it has always been studied as a negative condition, linked to psychopathology. Dickman (1990) proposed two subdimensions of impulsivity, dysfunctional (DI) and functional (FI). He defines the latter as the tendency for rapid, goal-oriented decision-making characterized by well calculated risks. Only a few studies have attempted to differentiate between these two subdimensions using classical neuropsychological tests. Fifty two drug addicts in treatment were tested using Dickman's Impulsivity Inventory and a battery of classical neuropsychological tests. FI shows moderate to high correlations with many classical neuropsychological test scores in relation to enhanced executive functioning, whereas DI reveals surprisingly weak and scarce correlations with indicators of impaired executive functioning. DI appears to be a trait related to some difficulties in classical neuropsychological tests, while FI emerges as a consistent and much stronger predictor of higher attention capacity, lower distractibility, better precision, fewer errors, and better maintenance of goal-oriented strategies. Thus, functional impulsivity is related to positive conditions and more efficient cognitive functioning. Implications for the treatment of drug addictions are suggested.

Caracterización neuropsicológica de la impulsividad funcional y disfuncional en adictos a sustancias: implicaciones clínicas / Neuropsychological characterization of functional and dysfunctional impulsivity in drug addicts: clinical implications

La impulsividad es una de las variables más consistentemente vinculadas a las distintas fases del proceso adictivo. Sin embargo, casi siempre se ha estudiado como una condición negativa, vinculada a psicopatología. Dickman (1990) propuso dos tipos de impulsividad, una disfuncional (ID) y otra funcional (IF). A ésta última la definió como la tendencia a tomar decisiones rápidas, orientadas a metas, mediante un proceso de toma de decisiones con riesgo calculado. Pocos estudios han abordado la caracterización neuropsicológica de ambas variantes, relacionándolas con el rendimiento en pruebas clásicas. Una muestra de 52 sujetos adictos en tratamiento cumplimentó el Dickman Impulsivity Inventory y una batería de pruebas neuropsicológicas clásicas. Se observaron correlaciones de débiles a moderadas entre la IF e indicadores de éxito en las tareas neuropsicológicas, mientras que la ID mostró una relación difusa y débiles correlaciones con indicadores de mal rendimiento en todas las tareas. La ID se mostró como una disposición que dificulta la realización de las tareas de forma global, sin interferencia específica, en tanto que la IF se relacionó consistentemente con mayor precisión, menor número de errores y mejor mantenimiento de los planes, y ello a partir de una mejor gestión atención al y una mayor resistencia al ruido. Se sugieren las implicaciones de cara a los tratamientos de las adicciones(AU)

Impulsivity is a stable correlate through out the course of drug addiction. However, it has always been studied as a negative condition, linked to psychopathology. Dickman (1990) proposed two sub dimensions of impulsivity, dysfunctional (DI) and functional (FI). He defines the latter as the tendency for rapid, goal-oriented decision-making characterized by well calculated risks. Only a few studies have attempted to differentiate between these two sub dimensions using classical neuropsychological tests. Fifty two drug addicts in treatment were tested using Dickman’s Impulsivity Inventory and a battery of classical neuropsychological tests. FI shows moderate to high correlations with many classical neuropsychological test scores in relation to enhanced executive functioning, whereas DI reveals surprisingly weak and scarce correlations with indicators of impaired executive functioning. DI appears to be a traitrelated to some difficulties in classical neuropsychological tests, while FI emerges as a consistent and much stronger predictor of higher attention capacity, lower distractibility, better precision, fewer errors, and better maintenance of goal-oriented strategies. Thus, functional impulsivity is related to positive conditions and more efficient cognitive functioning. Implications for the treatment of drug addictions are suggested(AU)

Fluidez verbal escrita en el envejecimiento normal con quejas subjetivas de memoria y en el deterioro cognitivo leve / Written verbal fluency in normal aging with subjective memory complaints and mild cognitive impairment

Introducción: El presente estudio analiza si una tarea de fluidez verbal escrita es útil para discriminar el deterioro cognitivo leve (DCL) frente al envejecimiento normal con quejas subjetivas de memoria (EN). Método: Se reclutaron 140 participantes con un juicio clínico de EN (n=64) o DCL (n=76) diagnosticado ad hoc a los que se les administró una tarea de fluidez verbal fonológica y semántica escrita. Resultados: El análisis descriptivo muestra una composición homogénea de los grupos en función de la edad, sexo y años de escolaridad. Se observa cómo, tanto la puntuación en cada criterio de evocación particular, como los sumatorios de los tres criterios fonológicos (FAS) y semánticos (SEMÁNTICA) son superiores en el grupo con EN que en el grupo con DCL (F=1.899, p<0.005, para FAS y F=24.200, p<0.001, para SEMÁNTICA). El trabajo analiza también las correlaciones con diferentes pruebas clásicas de cribado. Discusión: Los resultados muestran la utilidad de la fluidez verbal escrita en el cribado del DCL. Esta modalidad ofrece frente a la modalidad oral, además, la ventaja añadida de su posible aplicación grupal. Se han observado las diferencias ya conocidas entre los criterios de evocación fonológica y semántica, concluyendo que los segundos aportan más información para el cribado de pacientes con DCL (AU)

Introduction: The present study analyzes whether a written verbal fluency task is suitable to differentiate between Mild Cognitive Impairment (MCI) and Normal Aging with subjective memory complaints (NA). Method: 140 subjects with a clinical judgement of NA (n=64) and MCI (n=76), diagnosed ad hoc, were administered both a verbal phonological fluency task and a verbal semantic fluency task. Results: The descriptive analysis of the data shows a homogeneous distribution of both groups taking into account age, gender and education. The group with NA scores significantly higher than the group with MCI on every indivicual criterion of evocation and also on both the summation of the three phonological criteria (FAS) and the summation of the three semantic criteria (SEMANTIC), being F=1.899, p<0.005, for FAS and F=24.200, p<0.001, for SEMANTIC. The study also analyzes the correlations of the written verbal tasks with several classical screening tests. Discussion: The results support the suitability of the written verbal fluency tasks on the screening of MCI. Further, this assessment procedure offers, too, the benefit of its possibility of administration to a group of people. Differences between the phonological evocation criteria and the semantic evocation criteria were con-firmed in this study, concluding that the latter are more reliable at the screening of people with MCI than the former (AU)