Diez años del inventario de síntomas prefrontales (ISP). Una revisión sistemática / Ten years of the prefrontal symptoms inventory (PSI). A systematic review

Introducción: Hace 10 años, Revista de Neurología publicaba la validación de una nueva herramienta gratuita: el inventario de síntomas prefrontales (ISP), de la que posteriormente se extrajo su versión abreviada (ISP-20). Durante esta década, los autores han acreditado sus excelentes propiedades psicométricas y su utilidad clínica. La presente revisión sistemática, sometida a la declaración PRISMA, tiene el objetivo de analizar el corpus de investigación que ha utilizado el ISP o el ISP-20, para valorar su trascendencia en otros equipos de investigación, en otras poblaciones clínicas e incluso en otras culturas. Materiales y métodos: Se buscaron artículos que hayan utilizado el inventario para realizar trabajos empíricos, en español, inglés, francés y portugués. Finalmente, se seleccionaron 56 trabajos. Resultados: Los resultados muestran que el ISP y el ISP-20 han tenido un uso elevado en España, así como en otros países de habla hispana (Argentina, Chile, Colombia, Cuba, Ecuador o Venezuela), y un uso moderado en países de habla no hispana (Bélgica, Brasil, Suecia o Suiza). Las poblaciones clínicas en las que se han utilizado abarcan desde el daño cerebral adquirido y las demencias degenerativas hasta el dolor crónico, la fibromialgia, las conductas adictivas o los trastornos de la personalidad. Dada su versatilidad, también se han usado con población general, incluyendo población reclusa, mujeres en entorno rural, estudiantes universitarios o para el estudio de la reserva cognitiva. Conclusiones: El ISP y el ISP-20 son instrumentos útiles para la investigación y la clínica, cuyo siguiente desafío es la validación de una versión en inglés, en la que se está trabajando.(AU)

Introduction: Ten years ago, Revista de Neurología published the validation of a new free tool: the Prefrontal Symptoms Inventory (PSI), from which an abbreviated version (PSI-20) was subsequently extracted. Over this decade, authors have demonstrated its excellent psychometric properties and clinical usefulness. This systematic review, conducted in accordance with the PRISMA statement, aims to analyse the body of research that has used the PSI or PSI-20 in order to assess its relevance in other research teams, other clinical populations and even other cultures. Materials and methods: A search was conducted to find articles written in Spanish, English, French and Portuguese that have used the inventory to carry out empirical research. Finally, 56 articles were selected. Results: The results show that the PSI and the PSI-20 have been widely used in Spain as well as in other Spanish-speaking countries (Argentina, Chile, Colombia, Cuba, Ecuador or Venezuela) and employed to a moderate extent in non-Spanish-speaking countries (Belgium, Brazil, Sweden or Switzerland). The clinical populations in which they have been used range from acquired brain injury and degenerative dementias to chronic pain, fibromyalgia, addictive behaviours or personality disorders. Given their versatility, they have also been used with the general population, including prison inmates, women in rural areas, university students or to study cognitive reserve. Conclusions: The PSI and PSI-20 are useful instruments for research and clinical use, and the next challenge is to validate an English version, which is currently being worked on.Key words. Activities of daily living. Neurologic symptoms. Neuropsychology. Prefrontal symptom inventory. Psychometrics. Systematic review.(AU)

[Ten years of the prefrontal symptoms inventory (PSI). A systematic review]. / Diez años del inventario de síntomas prefrontales (ISP). Una revisión sistemática.

INTRODUCTION: Ten years ago, Revista de Neurologia published the validation of a new free tool: the Prefrontal Symptoms Inventory (PSI), from which an abbreviated version (PSI-20) was subsequently extracted. Over this decade, authors have demonstrated its excellent psychometric properties and clinical usefulness. This systematic review, conducted in accordance with the PRISMA statement, aims to analyse the body of research that has used the PSI or PSI-20 in order to assess its relevance in other research teams, other clinical populations and even other cultures. MATERIALS AND METHODS: A search was conducted to find articles written in Spanish, English, French and Portuguese that have used the inventory to carry out empirical research. Finally, 56 articles were selected. RESULTS: The results show that the PSI and the PSI-20 have been widely used in Spain as well as in other Spanish-speaking countries (Argentina, Chile, Colombia, Cuba, Ecuador or Venezuela) and employed to a moderate extent in non-Spanish-speaking countries (Belgium, Brazil, Sweden or Switzerland). The clinical populations in which they have been used range from acquired brain injury and degenerative dementias to chronic pain, fibromyalgia, addictive behaviours or personality disorders. Given their versatility, they have also been used with the general population, including prison inmates, women in rural areas, university students or to study cognitive reserve. CONCLUSIONS: The PSI and PSI-20 are useful instruments for research and clinical use, and the next challenge is to validate an English version, which is currently being worked on.

TITLE: Diez años del inventario de síntomas prefrontales (ISP). Una revisión sistemática.Introducción. Hace 10 años, Revista de Neurología publicaba la validación de una nueva herramienta gratuita: el inventario de síntomas prefrontales (ISP), de la que posteriormente se extrajo su versión abreviada (ISP-20). Durante esta década, los autores han acreditado sus excelentes propiedades psicométricas y su utilidad clínica. La presente revisión sistemática, sometida a la declaración PRISMA, tiene el objetivo de analizar el corpus de investigación que ha utilizado el ISP o el ISP-20, para valorar su trascendencia en otros equipos de investigación, en otras poblaciones clínicas e incluso en otras culturas. Materiales y métodos. Se buscaron artículos que hayan utilizado el inventario para realizar trabajos empíricos, en español, inglés, francés y portugués. Finalmente, se seleccionaron 56 trabajos. Resultados. Los resultados muestran que el ISP y el ISP-20 han tenido un uso elevado en España, así como en otros países de habla hispana (Argentina, Chile, Colombia, Cuba, Ecuador o Venezuela), y un uso moderado en países de habla no hispana (Bélgica, Brasil, Suecia o Suiza). Las poblaciones clínicas en las que se han utilizado abarcan desde el daño cerebral adquirido y las demencias degenerativas hasta el dolor crónico, la fibromialgia, las conductas adictivas o los trastornos de la personalidad. Dada su versatilidad, también se han usado con población general, incluyendo población reclusa, mujeres en entorno rural, estudiantes universitarios o para el estudio de la reserva cognitiva. Conclusiones. El ISP y el ISP-20 son instrumentos útiles para la investigación y la clínica, cuyo siguiente desafío es la validación de una versión en inglés, en la que se está trabajando.

Análisis psicométrico del inventario de síntomas prefrontales abreviado: evidencias de su validez y fiabilidad en la población general venezolana / Psychometric analysis of the prefrontal symptom inventory abbreviated: evidence of its validity and reliability in the general Venezuelan population

Introducción: Existen pocas herramientas para medir objetivamente las disfunciones de origen prefrontal autoinformadas por la población general. El inventario de síntomas prefrontales (ISP) es una prueba con excelentes propiedades psicométricas que permite dicha evaluación, y hasta el momento no se han realizado análisis robustos de su versión abreviada en castellano para Latinoamérica. Objetivo: Analizar las propiedades psicométricas del ISP abreviado, en términos de fiabilidad y validez en la población general dentro del contexto venezolano. Sujetos y métodos: Participaron 300 sujetos de población general. La estructura factorial del ISP abreviado se determinó a través del análisis factorial confirmatorio; la validez de constructo se evaluó a partir del contraste de grupos con/sin riesgo de deterioro cognitivo leve y la convergencia de puntuaciones con los dominios que componen la prueba cognitiva de Montreal (MoCA). Asimismo, se estimó la consistencia interna través de la omega de McDonald y el alfa de Cronbach. Resultados: Se contrastaron cinco modelos factoriales y se obtuvo una versión del ISP compuesta por 18 ítems, que presentó excelentes indicadores de bondad de ajuste: ?2 (132) = 200,057, p < 0,001, índice de ajuste comparativo = 0,955, índice de Tucker Lewis = 0,948, raíz cuadrática estandarizada de las medias residuales = 0,042, raíz cuadrática de la media del error de aproximación = 0,041; y consistencia interna (omega = 0,9; alfa = 0,89). Asimismo, se evidenciaron diferencias estadísticamente significativas entre grupos y correlaciones inversas con los apartados evaluados en la MoCA a excepción de la abstracción. Conclusión: El ISP-18 es una medida válida y confiable para ser utilizada en la población estudiada. Consistentemente, estudios previos dan cuenta de su versatilidad para que se use en investigación y en contextos de salud.(AU)

Introduction: Few tools exist to objectively measure dysfunctions of prefrontal origin self-reported by the general population. The Prefrontal Symptom Inventory (PSI) is a test with excellent psychometric properties that allows such assessment and so far, no robust analysis of its abbreviated version in Spanish for Latin America has been performed. Aims To analyze the psychometric properties of the abbreviated PSI in terms of reliability and validity in the general population in the Venezuelan context. Subjects and methods: 300 subjects from the general population participated. The factor structure of the abbreviated ISP was determined through confirmatory factor analysis (CFA); construct validity was assessed by contrasting groups with no risk of MCI and the convergence of scores with the domains that make up the Montreal Cognitive Assessment (MoCA). Likewise, internal consistency was estimated through McDonald’s w and Cronbach’s a. Results: Five factorial models were contrasted and a version of the PSI composed of 18 items was obtained, which presented excellent indicators of goodness of fit (c2 (132) = 200.057, p < 0.001, CFI=0.955, TLI=0.948, SRMR=0.042, RMSEA=0.041) and internal consistency (w = 0.90; a = 0.89). Likewise, statistically significant differences between groups and inverse correlations were evidenced with the sections evaluated in the MoCA except for abstraction. Conclusion: The PSI-18 is a valid and reliable measure to be used in the studied population. Consistently, previous studies show its versatility to be used in research and health contexts.(AU)

Fragilidad y riesgo de dependencia: el cuestionario de Barber en estudios poblacionales / Frailty and risk of dependency: Barber's questionnaire in population based studies

Introducción: La dependencia funcional es un problema creciente, vinculado al incremento de edad, especialmente en países industrializados. Los estudios poblacionales permiten un acercamiento a la magnitud del problema. Objetivo: El cuestionario de Barber es un instrumento ampliamente utilizado para la detección de riesgo de dependencia, vulnerabilidad o fragilidad en adultos mayores. No se han encontrado trabajos que lo apliquen en estudios poblacionales, en los que, por su sencillez, podría resultar útil. Metodología: Se incluyó el cuestionario en una encuesta de salud, con una muestra representativa (n = 1.882 sujetos) de personas de 65 años o más, de una gran ciudad (Madrid, España) y se presentan las evidencias de validez basada en la estructura interna y la relación con otras variables de tipo convergente y discriminante. Resultados: Se obtuvo una solución unifactorial, con adecuada consistencia interna según varios indicadores multivariados. Se encontraron diferencias significativas por sexo, tanto al nivel de la escala como de los ítems. También aparecieron correlaciones significativas entre la puntuación total de la prueba y la de otras variables, como la calidad de vida relacionada con la salud, la edad y la sensación de soledad. Un 58,1% de la muestra obtuvo puntuaciones que sugieren vulnerabilidad (el 65,3% de las mujeres). Conclusiones: Los resultados sugieren la utilidad del cuestionario de Barber, como prueba fiable y válida, para detectar situaciones de fragilidad o vulnerabilidad en adultos mayores, lo que facilitaría la comparabilidad entre encuestas poblacionales, superando la actual tendencia a incluir decenas de preguntas en otras encuestas de índole regional o nacional (AU)

Introduction: Functional dependence is a growing problem, linked to increasing age, especially in industrialized countries. Population studies allow an approach to the magnitude of the problem. Objectives: Barber's questionnaire is a widely used instrument for the detection of risk of dependence, vulnerability or frailty in older adults. No works have been found that apply it in population-based studies, where, due to its simplicity, it could be useful. Methodology: The questionnaire was included in a Health Survey, with a representative sample (n = 1,882 subjects) of people aged 65 years or more, from a big city (Madrid, Spain) and the evidence of validity is presented based on the internal structure and the relationship with other variables of convergent and discriminant type. Results: A unifactorial solution was obtained, with adequate internal consistency according to several multivariate indicators. Significant differences were found by sex, both at the scale and item level. Significant correlations also appeared between the total test score and other variables, such as health-related quality of life, age, and sense of loneliness. A total of 58.1% of the sample obtained scores suggesting vulnerability (65.3% of the women). Conclusions: The results suggest the usefulness of the Barber questionnaire, as a reliable and valid test, to detect situations of frailty or vulnerability in older adults, which would facilitate comparability between population surveys, overcoming the current tendency to include dozens of questions in other regional or national surveys (AU)

[Psychometric analysis of the prefrontal symptom inventory abbreviated: evidence of its validity and reliability in the general Venezuelan population]. / Análisis psicométrico del inventario de síntomas prefrontales abreviado: evidencias de su validez y fiabilidad en la población general venezolana.

INTRODUCTION: Few tools exist to objectively measure dysfunctions of prefrontal origin self-reported by the general population. The Prefrontal Symptom Inventory (PSI) is a test with excellent psychometric properties that allows such assessment and so far, no robust analysis of its abbreviated version in Spanish for Latin America has been performed. AIMS: To analyze the psychometric properties of the abbreviated PSI in terms of reliability and validity in the general population in the Venezuelan context. SUBJECTS AND METHODS: 300 subjects from the general population participated. The factor structure of the abbreviated ISP was determined through confirmatory factor analysis (CFA); construct validity was assessed by contrasting groups with no risk of MCI and the convergence of scores with the domains that make up the Montreal Cognitive Assessment (MoCA). Likewise, internal consistency was estimated through McDonald's ? and Cronbach's a. RESULTS: Five factorial models were contrasted and a version of the PSI composed of 18 items was obtained, which presented excellent indicators of goodness of fit (?2 (132) = 200.057, p < 0.001, CFI=0.955, TLI=0.948, SRMR=0.042, RMSEA=0.041) and internal consistency (? = 0.90; a = 0.89). Likewise, statistically significant differences between groups and inverse correlations were evidenced with the sections evaluated in the MoCA except for abstraction. CONCLUSION: The PSI-18 is a valid and reliable measure to be used in the studied population. Consistently, previous studies show its versatility to be used in research and health contexts.

TITLE: Análisis psicométrico del inventario de síntomas prefrontales abreviado: evidencias de su validez y fiabilidad en la población general venezolana.Introducción. Existen pocas herramientas para medir objetivamente las disfunciones de origen prefrontal autoinformadas por la población general. El inventario de síntomas prefrontales (ISP) es una prueba con excelentes propiedades psicométricas que permite dicha evaluación, y hasta el momento no se han realizado análisis robustos de su versión abreviada en castellano para Latinoamérica. Objetivo. Analizar las propiedades psicométricas del ISP abreviado, en términos de fiabilidad y validez en la población general dentro del contexto venezolano. Sujetos y métodos. Participaron 300 sujetos de población general. La estructura factorial del ISP abreviado se determinó a través del análisis factorial confirmatorio; la validez de constructo se evaluó a partir del contraste de grupos con/sin riesgo de deterioro cognitivo leve y la convergencia de puntuaciones con los dominios que componen la prueba cognitiva de Montreal (MoCA). Asimismo, se estimó la consistencia interna través de la omega de McDonald y el alfa de Cronbach. Resultados. Se contrastaron cinco modelos factoriales y se obtuvo una versión del ISP compuesta por 18 ítems, que presentó excelentes indicadores de bondad de ajuste: ?2 (132) = 200,057, p menor de 0,001, índice de ajuste comparativo = 0,955, índice de Tucker Lewis = 0,948, raíz cuadrática estandarizada de las medias residuales = 0,042, raíz cuadrática de la media del error de aproximación = 0,041; y consistencia interna (omega = 0,9; alfa = 0,89). Asimismo, se evidenciaron diferencias estadísticamente significativas entre grupos y correlaciones inversas con los apartados evaluados en la MoCA a excepción de la abstracción. Conclusión. El ISP-18 es una medida válida y confiable para ser utilizada en la población estudiada. Consistentemente, estudios previos dan cuenta de su versatilidad para que se use en investigación y en contextos de salud.

[Long-acting reversible contraception methods in women under 26 years of age]. / Métodos anticonceptivos de larga duración en mujeres menores de 26 años.

OBJECTIVES: Long-acting reversible contraception (LARC) methods have proven their high safety and efficacy for pregnancy prevention and they are specially indicated in young and vulnerable population, but their use encounter barriers both between providers and users due to lack of information or to the economic cost. The aim of this study was to assess the use of two LARC methods, intrauterine device (IUD) and implant, in minors under 26 years old after giving an adequate contraceptive advice and subsidizing them in vulnerability situations. To analyze the population that chooses them, the side effects, the reasons for abandoning and the permanence time. MATERIAL AND METHODS: Retrospective descriptive study of IUD and implants inserted to minors under 26 years old from January 2016 to December 2019 at the Municipal Health Center of Usera belonging to Madrid Salud. Data is collected from n=266 women who started using IUD or implant. 87 copper IUD, 37 medicated IUD and 142 implants have been placed. RESULTS: Increased prescription of both methods, with significant implant use in the last year of the study. There has been vulnerability in 91.7% of women. The average age of IUD users is about 21.4 years, almost 2 years older than that of the implant and they have more children. The side effects frequency has been similar with both methods, being abnormal bleeding as the most frequent side effect. 31% of copper IUD, 32% of medicated IUD and 12% of implants have been removed early. The average permanence time was 19.3 months (SD=13.3), 89.1% remained at the end of the first year, 81.2% at two years and 77.4% at three years. CONCLUSIONS: An adequate contraceptive advice and free access are essential keys for increasing the LARC methods use in this particularly vulnerable population. Few and minor side effects and high continuity rate have been found, especially for the implant.

[Memory complaints: mental health, diseases, pain and loneliness. A population study in the city of Madrid]. / Quejas de memoria: salud mental, enfermedades, dolor y soledad. Estudio poblacional en la ciudad de Madrid.

INTRODUCTION: Subjective memory complaints (SMC) are considered predictor of cognitive impairment, but are also associated with other factors; social and lifestyle have been the least studied. AIM: To evaluate SMC and their association with epidemiological, health, social and lifestyle variables. SUBJECTS AND METHODS: Cross-sectional epidemiological study of the randomly selected population of Madrid. Telephone interview. TARGET POPULATION: 1,775 over 55 years of age. We asked about QSM, social, economic, health and lifestyle aspects. The Goldberg General Health Questionnaire (GHQ) and the COOP-Wonca Quality of Life Questionnaire were administered. RESULTS: We found statistically significant association of SMC with age, temporal orientation, all variables related to mental health (depression), anxiety, sleep, mental health/GHQ, and quality of life. Association was found with all pain variables and with loneliness. There was no association with specific diseases, except chronic allergy and those linked to pain. The predictors of the SMC were temporal orientation, multimorbidity, mental health/GHQ, anxiety, pain and feeling lonely. CONCLUSIONS: SMC is a multi-caused symptom. They are associated with lower memory performance, but also with variables related to health, social aspects and lifestyle. When faced with a patient with SMC, which may be due to cognitive impairment because of Alzheimer's disease, these associations should be taken into account to assess this risk and know when follow-up is most needed.

TITLE: Quejas de memoria: salud mental, enfermedades, dolor y soledad. Estudio poblacional en la ciudad de Madrid.Introducción. Las quejas subjetivas de memoria (QSM) se consideran predictoras del deterioro cognitivo, pero se asocian también a otros factores; los sociales y los hábitos de vida han sido los menos estudiados. Objetivo. Valorar las QSM y su asociación con variables epidemiológicas, de salud, sociales y hábitos de vida. Sujetos y métodos. Estudio epidemiológico trasversal de la población de Madrid elegida aleatoriamente según censo. Entrevista telefónica. Población diana: 1.775 mayores de 55 años. Se preguntó sobre QSM, aspectos sociales, económicos, de salud y hábitos de vida. Se administraron el cuestionario de salud general de Goldberg (GHQ) y el cuestionario de calidad de vida COOP-Wonca. Resultados. Encontramos asociación estadísticamente significativa de las QSM con la edad, la orientación temporal, todas las variables relacionadas con la salud mental (depresión), la ansiedad, el sueño, la salud mental/GHQ y la calidad de vida. Se halló asociación con todas las variables que miden el dolor y con sentir soledad. No hubo asociación con enfermedades específicas, excepto con la alergia crónica y las ligadas al dolor. Los predictores de las QSM fueron la orientación temporal, la multimorbilidad, la salud mental/GHQ, la ansiedad, el dolor y el sentir soledad. Conclusiones. Las QSM son un síntoma con múltiples causas. Se asocian a menor rendimiento de la memoria, pero también a variables relacionadas con la salud, los aspectos sociales y el tipo de vida. Ante un paciente con QSM, que pueden deberse al deterioro cognitivo por enfermedad de Alzheimer, deben considerarse estas asociaciones para valorar dicho riesgo y saber cuándo es más necesario un seguimiento.

Prefrontal symptomatology in People with Amyotrophic lateral Sclerosis: Clinical Utility and Psychometric Properties of Prefrontal Symptoms Inventory (PSI)

The Amyotrophic Lateral Sclerosis (ALS) is a multisystemic disorder. It is considered a neuromuscular disease but also involves cognitive (executive functions, social cognition, attention, memory and language), emotional or behavior changes in over 50% of the reported cases and to of frontotemporal diagnosis lobar degeneration of behavioral variant in up to 15% of the cases. For this reason, the presence of cognitive and motivational problems was analysed in a Spanish sample of ALS patients through the prefrontal symptoms inventory (PSI) to determine applicability in this disease STI. A sample of 31 patients with a potential ALS or definitive diagnostic criteria according to El Escorial was used. Obtained results ISP were compared with a sample of 31 healthy people in the same proportions of gender, age and education level. Obtained results showed a not significant difference between the two populations in the motivational factor problems, related to the depression symptomatology frequently associated with ALS. A significant positive correlation between age at diagnosis and the scale of the motivational problems was observed, with a not significant trend related to problems in the executive control and in social the behavior control and with the age at diagnosis, in the same sense with age at diagnosis. Therefore, it can be concluded that, despite the results obtained, emotional and behavioral deficits in ALS patients and symptoms related to frontotemporal dementia (among others, anosognosia or lack of consciousness symptoms) could have interfered in patient perception about their symptomatology

[Prefrontal symptoms in daily life: normalization and standardization of the Prefrontal Symptoms Inventory in the Spanish population]. / Sintomas prefrontales en la vida diaria: normalizacion y estandarizacion del inventario de sintomas prefrontales abreviado en poblacion española.

INTRODUCTION: The short Prefrontal Symptoms Inventory (PSI-20) is a questionnaire that investigates symptoms of prefrontal malfunctioning in daily life. It has been shown to have good psychometric properties and has been applied in the general population and clinical samples from Spain and other Spanish-speaking countries. AIMS: To normalise and standardise the PSI-20 in a broad sample of subjects of all ages in a Spanish population. SUBJECTS AND METHODS: The PSI-20 was administered to 4704 subjects: in one sample made up of 2474 subjects from the Spanish general population, over 18 years of age, and in another consisting of 2230 school-age subjects (15-17 years old), representative of the population of Madrid. RESULTS: The effect of the interaction of sex, age and level of education on the scores was observed, although the effect of level of education was low. As expected, the adolescents, still undergoing their process of maturation, obtained higher scores on all the subscales and the questionnaire as a whole. Females scored significantly higher on symptoms of poor emotional control, and males achieved higher scores on symptoms of poor control over social behaviour. Tables were developed differentiated by sex and for those above and below 18 years of age. CONCLUSION: The data presented allow us to interpret the scores obtained in the PSI-20 in the Spanish population, including subjects under 18 and adults.

TITLE: Sintomas prefrontales en la vida diaria: normalizacion y estandarizacion del inventario de sintomas prefrontales abreviado en poblacion española.Introduccion. El inventario de sintomas prefrontales abreviado (ISP-20) es un cuestionario que investiga sintomas de mal funcionamiento prefrontal en la vida diaria. Ha mostrado buenas propiedades psicometricas y se ha aplicado en poblacion general y muestras clinicas de España y otros paises de habla hispana. Objetivo. Normalizar y estandarizar el ISP-20 en una muestra amplia de sujetos de todas las edades en poblacion española. Sujetos y metodos. Se administro el ISP-20 a 4.704 sujetos: una muestra de 2.474 sujetos de poblacion general española, mayores de edad, y otra de 2.230 menores de edad escolarizados (15-17 años), representativa de la poblacion de Madrid. Resultados. Se observo el efecto de interaccion del sexo, la edad y el nivel educativo sobre las puntuaciones, aunque el nivel de estudios presenta un efecto bajo. Los adolescentes, como era de esperar por encontrarse en pleno proceso madurativo, obtuvieron mayores puntuaciones en todas las subescalas y el cuestionario en su conjunto. Las mujeres puntuaron significativamente mas en sintomas de mal control emocional, y los varones lo hicieron mas en sintomas de mal control de la conducta social. Se configuraron tablas diferenciadas por sexo y para menores y mayores de edad. Conclusion. Los datos presentados permiten interpretar las puntuaciones obtenidas en el ISP-20 en poblacion española, incluyendo los menores de edad y los adultos.

[The Prefrontal Symptoms Inventory (PSI) in acquired brain injury: agreement between the scores of patients, relatives and professionals]. / Inventario de sintomas prefrontales (ISP) en el daño cerebral adquirido: concordancia entre puntuaciones de paciente, familiar y profesional.

INTRODUCTION: The use of self-reports about symptoms of malfunctioning in daily life derived from functional deficits of a prefrontal origin has become widespread in clinical practice, since they allow incremental ecological validity to be added to other specific tests. Yet it remains to be determined whether self-assessment is sufficient on its own or if the participation of an external evaluator would be preferable. SUBJECTS AND METHODS: The Prefrontal Symptoms Inventory (PSI) was administered to 115 subjects being treated for a range of brain pathologies. The same test, referring to the patient, was administered to one of the professionals closely following the development of the case and, whenever possible (n = 88), a relative or caregiver. The psychometric goodness of the PSI was explored in the three samples, and the degree of correlation and agreement among the three assessments was estimated. RESULTS: The three assessments showed significant correlation, although the patients reported fewer symptoms than their relatives and caregivers in terms of executive functioning. The assessments of relatives and patients were superposed and showed a high degree of agreement as regards both profile and magnitude. CONCLUSIONS: In addition to the mandatory neuropsychological assessment, we recommend the administration of questionnaires or inventories about symptoms such as the PSI, with proven psychometric robustness, that make it possible to explore the impact of brain dysfunctions in daily functioning. Since many of these dysfunctions are accompanied by different degrees of anosognosia, they should be administered to external observers, relatives or professionals, with the intention of obtaining a more adequate assessment of the magnitude of the functional difficulties.

TITLE: Inventario de sintomas prefrontales (ISP) en el daño cerebral adquirido: concordancia entre puntuaciones de paciente, familiar y profesional.Introduccion. El uso de autoinformes sobre sintomas de mal funcionamiento en la vida diaria derivados de deficits funcionales de origen prefrontal se ha generalizado en la practica clinica, dado que permiten aportar validez ecologica incremental a otras pruebas especificas. Sin embargo, queda por determinar si la autoevaluacion es suficiente por si misma o es preferible la participacion de un evaluador externo. Sujetos y metodos. Se administro el inventario de sintomas prefrontales (ISP) a 115 sujetos en tratamiento por diversas patologias cerebrales. La misma prueba, referida al paciente, se administro a algun profesional que siguiera estrechamente la evolucion del caso y, cuando fue posible (n = 88), a un familiar o cuidador. Se exploro la bondad psicometrica del ISP en las tres muestras y se estimo el grado de correlacion y concordancia entre las tres evaluaciones. Resultados. Las tres evaluaciones mostraron correlacion significativa, aunque los pacientes declararon menos sintomas que sus familiares y cuidadores en funcionamiento ejecutivo. Las evaluaciones de familiares y pacientes se superpusieron y mostraron un alto grado de concordancia en perfil y magnitud. Conclusiones. Se recomienda, junto con la obligada evaluacion neuropsicologica, la cumplimentacion de cuestionarios o inventarios de sintomas como el ISP, con probada robustez psicometrica, que permitan explorar el impacto de las disfunciones cerebrales en el funcionamiento cotidiano. Dado que muchas de estas disfunciones se acompañan de diversos grados de anosognosia, se recomienda su administracion a observadores externos, familiares o profesionales, de cara a obtener una evaluacion mas adecuada de la magnitud de las dificultades funcionales.

[Prefrontal Symptoms Inventory (PSI): ecological validity and convergence with neuropsychological measures]. / Inventario de sintomas prefrontales (ISP): validez ecologica y convergencia con medidas neuropsicologicas.

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-to-day 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.

TITLE: Inventario de sintomas prefrontales (ISP): validez ecologica y convergencia con medidas neuropsicologicas.Introduccion. El inventario de sintomas 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 poblacion general como en multiples poblaciones clinicas. Existe una version abreviada de 20 items (ISP-20) con excelentes propiedades psicometricas para el cribado. Objetivo. Estudiar la validez convergente y divergente del ISP e ISP-20, analizando como sus escalas reflejan las consecuencias cotidianas de deficits reales hallados en evaluacion neuropsicologica mediante pruebas de ejecucion. Pacientes y metodos. Se estudiaron 52 personas con adiccion a sustancias en tratamiento (31 varones y 21 mujeres) a las que se administro el ISP junto con una bateria de exploracion neuropsicologica abreviada centrada en describir procesos atencionales, mnemicos y ejecutivos. Resultados. Ambas versiones del ISP presentan optimas propiedades psicometricas (0,78 > alfa > 0,94 para la version completa de 46 items y 0,7 > alfa > 0,89 para la version abreviada de 20 items). Los resultados confirman las hipotesis sobre su validez: la escala de problemas en la ejecucion 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 clinicamente util, psicometricamente valida y aplicable en multiples poblaciones clinicas.

Outcomes of a multicomponent intervention on occupational performance in persons with unilateral acquired brain injury.

Complications after unilateral acquired brain injury (ABI) can affect various areas of expertise causing (depending on the location of the lesion) impairment in occupational performance. The aim of this study was to analyze and compare the concepts of occupational performance and functional independence, both before and after a multicomponent intervention including occupational therapy, in persons with unilateral brain damage. This was a longitudinal quasi-experimental pretest post-test study in a sample of 58 patients with unilateral brain injury (28 with traumatic brain injury and 30 with ischemic stroke). The patients' level of independence was measured using the short version of the International Classification of Functioning, Disability and Health. We also measured quality of performance using the Assessment of Motor and Process Skills. The findings of this study showed that patients with injury in the right hemisphere improved more than those with left hemisphere damage (p<0.001). All the patients with ABI, especially those with right-sided injury, derived benefit from the multicomponent intervention, except in the area of motor skills. More research is needed on the specific techniques that might address such skills.

Functionality predictors in acquired brain damage.

INTRODUCTION: Most individuals who have survived an acquired brain injury present consequences affecting the sensorimotor, cognitive, affective or behavioural components. These deficits affect the proper performance of daily living activities. The aim of this study is to identify functional differences between individuals with unilateral acquired brain injury using functional independence, capacity, and performance of daily activities. METHOD: Descriptive cross-sectional design with a sample of 58 people, with right-sided injury (n=14 TBI; n=15 stroke) or left-sided injury (n = 14 TBI, n = 15 stroke), right handed, and with a mean age of 47 years and time since onset of 4 ± 3.65 years. The functional assessment/functional independence measure (FIM/FAM) and the International Classification of Functioning (ICF) were used for the study. RESULTS: The data showed significant differences (P<.000), and a large size effect (dr=0.78) in the cross-sectional estimates, and point to fewer restrictions for patients with a lesion on their right side. The major differences were in the variables 'speaking' and 'receiving spoken messages' (ICF variables), and 'Expression', 'Writing' and 'intelligible speech' (FIM/FAM variables). In the linear regression analysis, the results showed that only 4 FIM/FAM variables, taken together, predict 44% of the ICF variance, which measures the ability of the individual, and up to 52% of the ICF, which measures the individual's performance. Gait alone predicts a 28% of the variance. CONCLUSIONS: It seems that individuals with acquired brain injury in the left hemisphere display important differences regarding functional and communication variables. The motor aspects are an important prognostic factor in functional rehabilitation.

[Evaluation of the community integration of persons with lateralised post-acute acquired brain injury]. / Valoracion de la integracion en la comunidad de las personas con daño cerebral adquirido postagudo lateralizado.

INTRODUCTION. Hemispheric specialization is a topic of interest that has motivated an enormous amount of research in recent decades. After a unilateral brain injury, the consequences can affect various areas of specialization, leading, depending on the location of the injury, impairment in quality of life and community integration. PATIENTS AND METHODS. Cross-sectional study with a sample of 58 patients, 28 traumatic brain injury (TBI) and 30 cerebrovascular accidents, both lateralized. The level of integration in the community is measured by the Community Integration Questionnaire. RESULTS. There were three groups analyzed by considering unilateral injury (full sample, stroke sample, and TBI sample). Results showed a significantly high community integration of people with right hemisphere injury. However, to measure the level of community integration between TBI and stroke, the results showed no significant differences. CONCLUSION. According to the results of the study people with brain injury in the right hemisphere have a better community integration than people with lesions in the left hemisphere regardless of the origin of the lesions (vascular or traumatic). We discussed the reasons that may motivate the differences and clinical implications.

TITLE: Valoracion de la integracion en la comunidad de las personas con daño cerebral adquirido postagudo lateralizado.Introduccion. La especializacion hemisferica es un tema de interes que ha motivado un gran volumen de investigacion en las ultimas decadas. Tras una lesion cerebral lateralizada, las secuelas pueden afectar a diversas areas de especializacion, provocando, en funcion de la localizacion de la lesion, una afectacion en la calidad de vida y en la integracion comunitaria. Pacientes y metodos. Estudio transversal con una muestra de 58 pacientes, 28 con traumatismos craneoencefalicos (TCE) y 30 con accidentes cerebrovasculares (ACV), ambos lateralizados. El nivel de integracion en la comunidad se midio con el cuestionario de integracion comunitaria (CIQ). Resultados. De los grupos analizados teniendo en cuenta la lesion lateralizada (muestra completa, muestra de ACV y muestra de TCE), los resultados mostraron una significativamente mayor integracion comunitaria de las personas con lesion en el hemisferio derecho. Sin embargo, al medir el nivel de integracion comunitaria entre TCE y ACV, los resultados no mostraron diferencias significativas. Conclusion. Segun los resultados del estudio, las personas con lesion cerebral en el hemisferio derecho presentan una mejor integracion comunitaria que las personas con lesion en el hemisferio izquierdo, con independencia del origen de las lesiones (vascular o traumatica). Se discuten las razones que pueden motivar las diferencias y las implicaciones clinicas.

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

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.

[Prevalence of attention-deficit hyperactivity disorder in substance addiction: from screening to diagnosis]. / Prevalencia del trastorno por deficit de atencion/hiperactividad en adictos a sustancias: del cribado al diagnostico.

INTRODUCTION: There is a rich body of literature on the coexistence of diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and substance abuse/dependence. Prevalence, however, varies considerably from one work to another. AIMS: To apply an algorithm that takes into account all the criteria needed to reach an adequate diagnosis and to explore the conditions associated with false positives. PATIENTS AND METHODS: The diagnostic algorithm was applied using several tests in the different phases, i.e. the Attention Deficit Hyperactivity Disorder Self-Report Scale was used for screening, the Wender-Utah Rating Scale and the Parents' Rating Scale were administered for the retrospective diagnosis, and the self-administered Spanish version of the frontal behaviour scale and the perceived stress scale were used to study false positives. Symptoms of other axis I disorders were also explored and a battery of classic neuropsychological tests was administered. All this was carried out with a sample of 696 subjects whose treatment began in a care centre for drug addicts. RESULTS: The final prevalence was found to be 6.89%. The symptoms of the false positives in the screening test prior to consumption were similar to those of the true negatives, but in that moment those symptoms were similar to those of the true positives, with whom no differences were found in the neuropsychological performance. Generalised anxiety disorder was the one that showed the highest relation with false positives. CONCLUSIONS: The diagnostic category of ADHD is usually utilised indiscriminately to classify subjects with early-onset neurological disorders and those who present similar manifestations following the phase of active addiction to substances. There is a need for a neurological and neuropsychological study that goes beyond the mere symptoms so as to be able to carry out a suitable characterisation and treatment of a set of similar symptomatic manifestations, but with a very wide range of developmental and aetiopathogenic components.

[Cognitive remediation in addictions treatment]. / Rehabilitacion cognitiva en el tratamiento de las adicciones.

More recent theories of addiction suggest that neurocognitive mechanisms, such as attentional processing, cognitive control, and reward processing play a key role in the development or maintenance of addiction. Ultimately, the addiction (with or without substances) is based on the alteration of brain decision-making processes. The neurosciences, particularly those responsible for behavior modification, must take into account the neurobiological processes underlying the observable behavior. Treatments of addiction usually do not take into account these findings, which may be at the base of the low retention rates and high dropout rates of addicted patients. Considered as an alteration of brain functioning, addiction could be addressed successfully through cognitive rehabilitation treatments used in other clinical pathologies such as brain damage or schizophrenia. Although there are few studies, it is suggest that intervention to improve patients' cognitive functioning can improve the efficiency of well-established cognitive-behavioral therapies, such as relapse prevention. This paper reviews the available evidence on cognitive rehabilitation in treating addiction as well as in other pathologies, in order to formulate interventions that may be included in comprehensive rehabilitation programs for people with addictive disorders.

[Frontal symptoms in substance abusers under treatment using the Spanish version of the Frontal System Behaviour Scale]. / Sintomatología frontal en adictos a sustancias en tratamiento mediante la versión española de la escala de comportamiento frontal.

INTRODUCTION AND AIMS: There are different studies that suggest a relationship between frontal symptoms and substance addiction. The Frontal System Behavior Scale is a questionnaire used to consider the manifestations of three frontal syndromes: executive dysfunction, apathy and lack of inhibition. SUBJECTS AND METHODS: The Spanish version of the Frontal System Behavior Scale (FrSBe-Sp) is administered to 215 addicted individuals starting treatment and to 267 nonclinical participants. The FrSBe-Sp is a self-administered questionnaire of 46 items that evaluate the three syndromes afore- mentioned, in an estimation of baseline (before substance use) and in a present estimation (after substance consumption). RESULTS: The questionnaire shows suitable psychometric properties and convergent validity with another similar questionnaire (DEX-Sp). Statistically significant differences appear between the scores of the addicted individuals compared with the group control at the baseline, as well as, specially, the present time. CONCLUSIONS: The results point out the fact that possibly the alterations of frontal character were previous. Maybe they acted as some kind of risk factors at the beginning of substance use. Also, they have significantly increased during the phase of active substance use. The FrSBe-Sp seems to be a good instrument to explore, both synchronically and diachronically, symptoms of frontal type related to addictive behaviors. New hypotheses of special relevance for treatment of addictive behaviors are suggested.

[Dysexecutive symptoms in substance abusers under treatment using the Spanish version of the dysexecutive questionnaire (DEX-Sp)]. / Sintomatología disejecutiva en adictos a sustancias en tratamiento mediante la versión española del cuestionario disejecutivo (DEX-Sp).

INTRODUCTION AND AIMS: Dysexecutive syndrome has traditionally been related to alterations affecting the functioning of the frontal lobes of the brain. Different studies suggest that this syndrome is present in addicts to substances and, hence, the use of a brief questionnaire has been put forward as a way of carrying out an initial screening for the condition, prior to a thorough assessment of the executive functions by a neuropsychologist. SUBJECTS AND METHODS: The Spanish version of the dysexecutive questionnaire (DEX-Sp) was administered to 176 addicts who were beginning treatment and to 213 non-clinical (control) participants. The DEX is a 20-item self report that evaluates a wide range of dysexecutive symptoms. RESULTS: Statistically significant differences appeared between the scores of addicts and those obtained by the control group. Whereas males showed differences in the types of symptoms they reported, female addicts displayed more intense dysexecutive clinical features, which affected all the areas under frontal control. No significant differences were observed as regards the main drug of abuse. CONCLUSIONS: It can be established that a total score of 24 points or more on the complete DEX-Sp scale suggests the existence of dysexecutive symptoms that are clinically relevant. Likewise, scores of 33 points or more indicate a probable moderate or severe dysexecutive syndrome. The DEX seems to be an instrument that is sensitive, fast and easy to apply in the initial assessment of addicts who are seeking treatment.