Clinical validation of the Allen's Cognitive Level Screen in acquired brain injury.

BACKGROUND: The evaluation of functional cognition is a central concern in clinical practice. However, there are few standardized or validated tools, and many of them take too long, requiring screening tests. AIMS: To explore the convergent validity of the ACLS-5 with other cognitive screening test and functional independence test in a sample of people with acquired brain injury. Moreover, to examine the prediction of ACLS-5 on functioning and cognitive performance outcomes. MATERIALS AND METHODS: A cross-sectional design was applied following the guidelines of the STROBE checklist. A consecutive sample of people with acquired brain injury was recruited from rehabilitation centers. A cognitive screening test and daily living activity tests were implemented, such as ACLS-5, MoCA, Barthel, and FIM+FAM. Data were analyzed using non-parametric methods. In addition, a structural analysis and simple regression models were performed. RESULTS: Eighty patients with chronic acquired brain injury, with a mean age of 52, were recruited. All tests are significantly related to the ACLS-5 score, a moderate effect size for MoCA (ρ = 0.36), and a strong effect size for the other two (ρ > 0.50). CONCLUSIONS: ACLS-5 predicts functional and cognitive performance quickly and effectively, optimizing assessment time and avoiding mental fatigue or physical exhaustion.

Reliability and Validity of the Spanish Version of the Executive Function Performance Test (EFPT) in Assessing People in Treatment for Substance Addiction.

IMPORTANCE: Assessing people's executive function (EF) during addiction treatment makes it possible to design individualized occupational goals. OBJECTIVE: To determine the reliability and validity of the Spanish version of the Executive Function Performance Test (EFPT) in the occupational assessment of people being treated for substance addiction. DESIGN: Cross-sectional, observational study to determine the EFPT's internal consistency as well as its convergent and discriminant validity with complementary tests. SETTING: A public, free addiction treatment center operated by Madrid Salud (Madrid City Council, Spain). PARTICIPANTS: Fifty-two people referred to an occupational therapy department for evaluation and intervention. Inclusion was based on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) criteria for substance abuse or dependence; the exclusion criterion consisted of any circumstances that made it difficult for a person to understand or perform the test. OUTCOMES AND MEASURES: The EFPT, other occupational tests (Allen Cognitive Level Screen-5, Lowenstein Occupational Therapy Cognitive Assessment), and a battery of neuropsychological EF tests. RESULTS: The EFPT had an unequivocal unifactorial structure and showed strong correlations between its components and adequate consistency with the scales and the complete test. As expected, the EFPT correlated with the neuropsychological tests with a considerable effect size (-.40 < r < -.60). CONCLUSIONS AND RELEVANCE: The EFPT's psychometric properties are adequate to assess the EF of people being treated for substance addiction from an occupational perspective using real activities of daily living (ADLs). WHAT THIS ARTICLE ADDS: The results show that the EFPT can be used to assess performance of ADLs without needing to use tests from disciplines other than occupational therapy. Further studies in different sociocultural settings are needed to generalize the results.

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

Loewenstein Occupational Therapy Cognitive Assessment to Evaluate People with Addictions.

BACKGROUND: The LOTCA (Loewenstein Occupational Therapy Cognitive Assessment) battery is a cognitive screening test which is widely used in occupational health. However, no work has been found that explores its use in addiction treatment. OBJECTIVES OF STUDY: To explore the convergent validity of LOTCA with neuropsychological tests that assess related cerebral functional areas. METHODS: The LOTCA, along with a battery of neuropsychological tests, was administered to a sample of 48 subjects who start a treatment by substance or gambling addictions. FINDINGS: A correlational pattern was observed of a considerable magnitude between the effects of the LOTCA scales and those of some neuropsychological tests, but not with others. There is barely any convergence in measures with memory and executive function tests. RELEVANCE TO CLINICAL PRACTICE: There is a lack of research applying test of occupational assessment to populations of patients treated by addictive behaviors. The LOTCA seems to be a reliable and valid test for preliminary screening of function in certain cognitive areas, easy, and quick to use (around 30 minutes). However, it must be supplemented with other tests for a full and ecological assessment of patients. LIMITATIONS: An incident, small-size sample. RECOMMENDATIONS FOR FURTHER RESEARCH: New studies are needed to explore the applicability, diagnostic validity, and whole psychometric quality of the test in addiction-related treatment.

Systematic Review of Occupational Therapy in the Treatment of Addiction: Models, Practice, and Qualitative and Quantitative Research.

OBJECTIVE: The authors conducted a systematic review of theoretical models, professional practice, and research findings to understand occupational therapy's role in the treatment of addiction. METHOD: PubMed, Academic Search Premier, CINAHL, ERIC, OTseeker, and Google Scholar were searched to identify scientific journal articles, book chapters, or any other similar literature published from 1970 through July 2015 that addressed theoretical approaches, intervention models, and professional roles or were qualitative or quantitative studies in which occupational therapy had a central role. RESULTS: The literature search yielded 16 theoretical and professional role studies, 8 qualitative studies, and 14 quantitative studies. All studies had low levels of evidence, and all were case series, sometimes with very small samples. CONCLUSION: Although occupational therapy has been involved in the treatment of people with substance addiction and, more recently, with behavioral addictions for more than half a century, the research that has been published is poor.

Allen Cognitive Level Screen for the classification of subjects treated for addiction.

Introduction The Cognitive Disabilities Model (CDM) is an occupational approach that can allow the classification of the functional-cognitive abilities of persons with addictions. The objective of the study was to explore the applicability of the ACLS-5 to assess a sample of persons undergoing addiction-rehabilitation treatment. Methods A sample of 232 participants was recruited from an outpatient treatment centre in Madrid (Spain). The ACLS-5, the Montreal Cognitive Assessment (MoCA), and the Prefrontal Symptom Inventory (PSI) were administered. Sociodemographic and addiction-related data were also obtained. Results Half of the sample showed serious deficits in functional cognition, which ultimately could be related to problems in their daily performance. Scores of ACLS-5 showed significant correlations with the severity of addiction, with those obtained with the MoCA, and with attentional symptoms on the PSI scale. Conclusions The data suggest the applicability of the ACLS-5 in assessing the degree of functional cognition in subjects treated for addiction, providing evidence to support ecological validity and facilitating the development of well-targeted cognitive rehabilitation programmes from an occupational perspective. The use of occupational-based instruments to assess the functioning of those with addictions is a requirement of occupational therapy professionals working in this general area.

Inventario de síntomas prefrontales (ISP): validez ecológica y convergencia con medidas neuropsicológicas / Prefrontal Symptoms Inventory (PSI): ecological validity and convergence with neuropsychological measures

Introducción. El inventario de síntomas prefrontales (ISP) es un cuestionario autoinformado creado en España que interroga sobre alteraciones cognitivas, emocionales y comportamentales en las actividades de la vida diaria y que resulta aplicable tanto en población general como en múltiples poblaciones clínicas. Existe una versión abreviada de 20 ítems (ISP-20) con excelentes propiedades psicométricas para el cribado. Objetivo. Estudiar la validez convergente y divergente del ISP e ISP-20, analizando cómo sus escalas reflejan las consecuencias cotidianas de déficits reales hallados en evaluación neuropsicológica mediante pruebas de ejecución. Pacientes y métodos. Se estudiaron 52 personas con adicción a sustancias en tratamiento (31 varones y 21 mujeres) a las que se administró el ISP junto con una batería de exploración neuropsicológica abreviada centrada en describir procesos atencionales, mnémicos y ejecutivos. Resultados. Ambas versiones del ISP presentan óptimas propiedades psicométricas (0,78 > alfa > 0,94 para la versión completa de 46 ítems y 0,7 > alfa > 0,89 para la versión abreviada de 20 ítems). Los resultados confirman las hipótesis sobre su validez: la escala de problemas en la ejecución se relaciona con la capacidad para resolver tests que presumiblemente valoran funciones ejecutivas de origen prefrontal (validez convergente), mientras que las escalas de problemas en el control emocional y problemas en la conducta social no se relacionan con dichas capacidades cognitivas (validez discriminante). Conclusiones. El ISP es una prueba clínicamente útil, psicométricamente válida y aplicable en múltiples poblaciones clínicas (AU)

Introduction. The Prefrontal Symptoms Inventory (PSI) is a self-reported questionnaire, created in Spain, which asks about cognitive, emotional and behavioural alterations in activities of daily living and which can be applied in both the general population and in multiple clinical populations. There is a shorter 20-item version (PSI-20) with excellent psychomotor properties for screening. Aim. To study the convergent and divergent validity of the PSI and PSI-20, by analysing how their scales reflect the day-today consequences of real deficits found in neurological assessment performed by means of performance tests. Patients and methods. A sample of 52 persons undergoing treatment for substance addiction (31 males and 21 females) were administered the PSI together with an abbreviated neuropsychological examination battery focused on describing attentional, mnemonic and executive processes. Results. Both versions of the PSI present optimal psychometric properties (0.78 > alpha > 0.94 for the complete 46-item version and 0.7 > alpha > 0.89 for the abbreviated 20-item version). The results confirm the hypotheses regarding their validity: the performance problems scale is related with the capacity to resolve tests that supposedly rate the executive functions of a prefrontal origin (convergent validity), whereas the scales of problems in emotional control and problems with social behaviour are not related with those cognitive capabilities (discriminant validity). Conclusions. The PSI is a test that is clinically useful, psychometrically valid and applicable in multiple clinical populations (AU)

Terapia ocupacional en adicciones: de la teoría a la práctica / Occupational therapy in addiction: from theory to practice

La Terapia Ocupacional es una disciplina cuyo marco conceptual, objetivos y métodos están bien establecidos. Uno de los ámbitos en los que interviene es el de la adicción. Sin embargo, los textos y artículos ocupacionales disponibles carecen, en muchos casos, de un marco explicativo propio, recurriendo con demasiada frecuencia a otros importados de disciplinas preponderantes. Ello lleva, por una parte, a una pobre producción científica y, por otra, a un rol secundario de nuestra disciplina en los programas terapéuticos. El presente trabajo recoge la propuesta de un marco explicativo de la adicción desde una perspectiva ocupacional. Algunos autores parten de considerar que la propia adicción es, en sí misma, una ocupación, en la medida en que proporciona un rol y una significación al propio adicto. Desde esta perspectiva, toman sentido ocupacional paradigmas experimentales recientes, como el del enriquecimiento ambiental, o conceptos como el de empoderamiento. La rehabilitación cognitiva funcional, ampliamente aplicada en clínica del daño cerebral, representa otro enfoque complementario en la clínica de la adicción. Existen instrumentos de evaluación propios que cuantifican o sistematizan las variables ocupacionales relevantes. La Terapia Ocupacional está en condiciones de asumir un rol propio, protagonista e irrenunciable en el tratamiento de la adicción.

Occupational Therapy is a discipline whose conceptual framework, objectives and methods are well established. Addiction is one of the areas in that is involved. However, the available occupational texts lacking in many cases its own explanatory framework, resorting too often to other imported from prevailing disciplines. This leads, on the one hand, to a poor scientific production and, on the other one, to a secondary role for our discipline in therapeutic programs. This paper presents a proposed explanatory framework of addiction from an occupational perspective. Some authors start considering that addiction is itself an occupation, to the extent that it provides a role and significance to the addict himself. From this perspective, it makes occupational sense some recent experimental paradigms, such as environmental enrichment, or concepts such as empowerment. The functional cognitive rehabilitation, widely applied in clinical of brain injury, represents another complementary approach to addiction clinic. There are own assessment instruments that measure or systematize the relevant occupational variables. Occupational Therapy is able to take its own role, main and indispensable prominence in the treatment of addiction.

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

Reserva cognitiva en adictos a sustancias en tratamiento: relación con el rendimiento cognitivo y las actividades cotidianas / Cognitive reserve in substance addicts in treatment: relation to cognitive performance and activities of daily living

Introducción. El concepto de reserva cognitiva ha ido ganando interés en la medida en que se ha acumulado evidencia sobre su relación con la resistencia del cerebro a declinar en su funcionamiento ante amenazas o alteraciones neurológicas. Aunque se ha estudiado en un gran número de alteraciones (degenerativas, traumáticas, psicopatológicas), pocos trabajos relacionan la reserva cognitiva con la adicción a sustancias, un proceso multidimensional con clara base neurológica. Objetivo. Explorar la reserva cognitiva de pacientes en tratamiento por adicción a drogas, relacionándolo con su rendimiento cognitivo en pruebas neuropsicológicas y en actividades de la vida diaria. Pacientes y métodos. Muestra de 57 pacientes en tratamiento por adicción a sustancias en un centro específico. Se administraron el cuestionario de reserva cognitiva, la evaluación cognitiva de Montreal y el inventario de síntomas prefrontales, y se recogieron variables relacionadas con la adicción. Resultados. Se encontró una relación positiva entre la reserva cognitiva y el tiempo de abstinencia, y negativa con la gravedad de la adicción. Aparecieron diferencias significativas según la reserva cognitiva en rendimiento neuropsicológico (especialmente en ciertos dominios cognitivos) y en actividades cotidianas. Conclusiones. La reserva cognitiva aparece como una variable relacionada con la adicción y los déficits cognitivos que la acompañan; resulta ser una potencial diana de las actividades rehabilitadoras, vinculada al paradigma de enriquecimiento ambiental, como estrategia para potenciar la resistencia frente al deterioro cognitivo que favorece y mantiene la adicción y para disminuir el potencial reforzador de la conducta de consumo (AU)

Introduction. The concept of cognitive reserve has gradually attracted more interest as a greater body of evidence has been collected on its relationship with the resistance of the brain to decline in its functioning when faced with neurological threats or disorders. Although a large amount of research has been conducted on (degenerative, traumatic, psychopathological) conditions, very few studies relate cognitive reserve with substance addiction, a multidimensional process with a clear neurological base. Aims. To explore the cognitive reserve of patients undergoing treatment for addiction to drugs of abuse by relating it with their cognitive performance in neuropsychological tests and in activities of daily living. Patients and methods. The study involved a sample of 57 patients being treated for substance abuse at a centre set up for this specific purpose. The cognitive reserve questionnaire, the Montreal cognitive assessment and the prefrontal symptoms inventory were administered, and variables related with the addiction were collected. Results. A positive relation was found between the cognitive reserve and the time of abstinence, and a negative one was seen with the severity of the addiction. Significant differences were observed according to the cognitive reserve in neuropsychological performance (especially in certain cognitive domains) and in daily activities. Conclusions. The cognitive reserve appears as a variable related to addiction and the cognitive deficits that accompany it. It is thus a potential target for rehabilitation activities and is linked to the environmental enrichment paradigm, as a strategy for enhancing resistance against the cognitive impairment that favours and maintains the addiction, and for lowering the reinforcing potential of the behaviour of consuming (AU)

[Cognitive reserve in substance addicts in treatment: relation to cognitive performance and activities of daily living]. / Reserva cognitiva en adictos a sustancias en tratamiento: relacion con el rendimiento cognitivo y las actividades cotidianas.

INTRODUCTION: The concept of cognitive reserve has gradually attracted more interest as a greater body of evidence has been collected on its relationship with the resistance of the brain to decline in its functioning when faced with neurological threats or disorders. Although a large amount of research has been conducted on (degenerative, traumatic, psychopathological) conditions, very few studies relate cognitive reserve with substance addiction, a multidimensional process with a clear neurological base. AIMS: To explore the cognitive reserve of patients undergoing treatment for addiction to drugs of abuse by relating it with their cognitive performance in neuropsychological tests and in activities of daily living. PATIENTS AND METHODS: The study involved a sample of 57 patients being treated for substance abuse at a centre set up for this specific purpose. The cognitive reserve questionnaire, the Montreal cognitive assessment and the prefrontal symptoms inventory were administered, and variables related with the addiction were collected. RESULTS: A positive relation was found between the cognitive reserve and the time of abstinence, and a negative one was seen with the severity of the addiction. Significant differences were observed according to the cognitive reserve in neuropsychological performance (especially in certain cognitive domains) and in daily activities. CONCLUSIONS: The cognitive reserve appears as a variable related to addiction and the cognitive deficits that accompany it. It is thus a potential target for rehabilitation activities and is linked to the environmental enrichment paradigm, as a strategy for enhancing resistance against the cognitive impairment that favours and maintains the addiction, and for lowering the reinforcing potential of the behaviour of consuming.

TITLE: Reserva cognitiva en adictos a sustancias en tratamiento: relacion con el rendimiento cognitivo y las actividades cotidianas.Introduccion. El concepto de reserva cognitiva ha ido ganando interes en la medida en que se ha acumulado evidencia sobre su relacion con la resistencia del cerebro a declinar en su funcionamiento ante amenazas o alteraciones neurologicas. Aunque se ha estudiado en un gran numero de alteraciones (degenerativas, traumaticas, psicopatologicas), pocos trabajos relacionan la reserva cognitiva con la adiccion a sustancias, un proceso multidimensional con clara base neurologica. Objetivo. Explorar la reserva cognitiva de pacientes en tratamiento por adiccion a drogas, relacionandolo con su rendimiento cognitivo en pruebas neuropsicologicas y en actividades de la vida diaria. Pacientes y metodos. Muestra de 57 pacientes en tratamiento por adiccion a sustancias en un centro especifico. Se administraron el cuestionario de reserva cognitiva, la evaluacion cognitiva de Montreal y el inventario de sintomas prefrontales, y se recogieron variables relacionadas con la adiccion. Resultados. Se encontro una relacion positiva entre la reserva cognitiva y el tiempo de abstinencia, y negativa con la gravedad de la adiccion. Aparecieron diferencias significativas segun la reserva cognitiva en rendimiento neuropsicologico (especialmente en ciertos dominios cognitivos) y en actividades cotidianas. Conclusiones. La reserva cognitiva aparece como una variable relacionada con la adiccion y los deficits cognitivos que la acompañan; resulta ser una potencial diana de las actividades rehabilitadoras, vinculada al paradigma de enriquecimiento ambiental, como estrategia para potenciar la resistencia frente al deterioro cognitivo que favorece y mantiene la adiccion y para disminuir el potencial reforzador de la conducta de consumo.

Assessment of motor and process skills in daily life activities of treated substance addicts.

AIM: The purpose of this study was to apply the Assessment of Motor and Process Skills (AMPS) in a sample of people in treatment for addictive behaviours and to study the results. METHODS: The test was applied to a sample of 101 outpatients in treatment for addiction to substances. The results were studied in relation to gender, age, level of education, and variables related to addiction. RESULTS: Motor and cognitive performance was negatively related to time of addiction and its severity. Sixty per cent of the sample reached suboptimal scores and 25% showed scores suggesting significant deterioration, especially with regard to cognitive processing skills. CONCLUSIONS: The AMPS seems to be a useful instrument to estimate the cognitive and motor impairment associated with addiction in daily life activities. The present work is the first to consider its applicability to drug users under treatment. The percentage of subjects affected and the magnitude of the observed impairment in the sample suggest the need to consider taking these deficits into account in treatment programmes and the convenience of incorporating functional rehabilitation as a basic element of the treatment of persons with addictions. Future studies should develop this instrument in larger samples, increasing the representativeness and generalizability of the results.

[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)

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)

[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)