Abstract
OBJECTIVEThis study sought to analyze the psychometric properties and diagnostic accuracy of the Chilean version of the INECO Frontal Screening (IFS-Ch) in a sample of dementia patients and control subjects.METHODSAfter adapting the instrument to the Chilean context and obtaining content validity evidence through expert consultation, the IFS-Ch was administered to 31 dementia patients and 30 control subjects together with other executive assessments (Frontal Assessment Battery [FAB], Modified version of the Wisconsin Card Sorting Test [MCST], phonemic verbal fluencies [letters A and P] and semantic verbal fluency [animals]) and global cognitive efficiency tests (Mini mental State Examination [MMSE] and Addenbrooke's Cognitive Examination-Revised [ACE-R]). Caregivers of dementia patients and proxies of control subjects were interviewed with instruments measuring dysexecutive symptoms (Dysexecutive Questionnaire [DEX]), dementia severity (Clinical Dementia Rating Scale [CDR]) and functional status in activities of daily living (Activities of Daily Living Scale [IADL] and Technology-Activities of Daily Living Questionnaire [T-ADLQ]). Convergent and discriminant validity, internal consistency reliability, cut-off points, sensitivity and specificity for the IFS-Ch were estimated.RESULTSEvidence of content validity was obtained. Evidence of convergent validity was also found showing significant correlations (p<0.05) between the IFS-Ch and the other instruments measuring: executive functions (FAB, r=0.935; categories achieved in the MCST, r=0.791; perseverative errors in the MCST, r= -0.617; animal verbal fluency, r=0.728; "A" verbal fluency, r=0.681; and "P" verbal fluency, r=0.783), dysexecutive symptoms in daily living (DEX, r= -0.494), dementia severity (CDR, r= -0.75) and functional status in activities of daily living (T-ADLQ, r= -0.745; IADL, r=0.717). Regarding reliability, a Cronbach's alpha coefficient of 0.905 was obtained. For diagnostic accuracy, a cut-off point of 18 points (sensitivity=0.903; specificity=0.867) and an area under curve of 0.951 were estimated to distinguish between patients with dementia and control subjects.DISCUSSIONThe IFS-Ch showed acceptable psychometric properties, supported by evidence of validity and reliability for its use in the measurement of executive functions in patients with dementia. The diagnostic accuracy of the IFS-Ch for detecting dementia patients was also considered acceptable.
Highlights
Subjects were divided into two groups: A clinical sample, including 31 patients recruited from the Cognitive Neurology and Dementias Unit (Unidad de Neurología Cognitiva y Demencias) of the Neurology Service at the Hospital del Salvador in Santiago, Chile
When these criteria were met, the Neurologist determined the specific type of dementia using multiple diagnostic criteria for AD (i. e., NINCDS-ADRDA), vascular dementia (i. e., ADDTC, NINDS-AIREN), Dementia with Lewy Bodies (i. e., third report of the dementia with Lewy bodies (DLB) Consortium) or frontotem
Minor modifications were made to the rest of the test administration procedure and scoring instructions in order to standardize the assessment procedure as much as possible
Summary
Executive functions constitute a group of higher order abilities that coordinate basic cognitive processes in order to regulate, control and execute goal-oriented behaviors that require new and creative solutions.[1,2,3] These include a wide range of cognitive processes such as inhibition, working memory, shifting, verbal reasoning, multitasking and planning,[4,5] all of which involve significant activity of the frontal lobes and “frontal lobe systems”, i. e. those areas with direct connections with the frontal lobes.[6]This cognitive domain is impaired in numerous neurological and neuropsychiatric pathologies, such as focal lesions involving the frontal lobes (abscesses, strokes or tumors), inflammatory diseases, neurodegenerative disorders, schizophrenia, obsessive compulsive disorder, etc.[7]. Executive functions constitute a group of higher order abilities that coordinate basic cognitive processes in order to regulate, control and execute goal-oriented behaviors that require new and creative solutions.[1,2,3] These include a wide range of cognitive processes such as inhibition, working memory, shifting, verbal reasoning, multitasking and planning,[4,5] all of which involve significant activity of the frontal lobes and “frontal lobe systems”, i. Executive deficits are prominent symptoms of some dementia syndromes, such as frontotemporal dementia (behavioral variant)[9] and vascular dementia[10,11] the assessment of this cognitive domain contributes to the differential diagnosis of the specific type of dementia
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