Chilean version of the INECO Frontal Screening (IFS-Ch): Psychometric properties and diagnostic accuracy

Ihnen, Josefina; Antivilo, Andrés; Muñoz-Neira, Carlos; Slachevsky, Andrea

doi:10.1590/S1980-57642013DN70100007

ABSTRACT

Objective:

This 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

Methods:

After 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.

Results:

Evidence 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.

Discussion:

The 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.

Key words:
INECO Frontal Screening; executive functions; neuropsychological tests; dementia

RESUMO

Objetivo:

Analisar as propriedades psicométricas e utilitário de diagnóstico da versão chilena do rastreio frontal INECO (IFS-Ch) em uma amostra de pacientes com demência e controles.

Métodos:

Após a adaptação do instrumento para o contexto chileno e obtenção de evidências de validade de conteúdo, o IFS-Ch foi administrado a 31 pacientes com demência e 30 indivíduos do grupo controle, além de outros testes de eficiência cognitiva global e executiva. Cuidadores de pacientes com demência e informantes de indivíduos controles foram entrevistados com instrumentos de medidas de sintomas disexecutivos, gravidade da demência e estado funcional nas atividades da vida diária. Validade convergente e discriminante, consistência interna, pontos de corte, sensibilidade e especificidade para o IFS-Ch foram estimados.

Resultados:

A evidência de validade de conteúdo foi obtida através de consulta a um especialista. Evidências de validade convergente foram encontrados, bem como, descritas correlações significativas entre o IFS-Ch e outros instrumentos de medidas: de funções executivas (FAB, r=0,935; categorias alcançadas no MCST, r=0,791; erros perseverativos na MCST, r= -0,617; fluência verbal animais, r=0,728; "A" de fluência verbal, r=0,681; gravidade de demência e fluência verbal de "P", r=0,783), sintomas disexecutivos na vida diária (DEX, r= -0,494), (CDR, r= -0,75) e estado funcional nas atividades da vida diária (T-ADLQ, r= -0,745; AIVD, r=0,717). Quanto à confiabilidade, coeficiente alfa de Cronbach de 0,905 foi obtido. Quanto a utilidade de diagnóstico, um ponto de corte de 18 pontos (sensibilidade=0,903, especificidade=0,867) e uma área sob a curva de 0,951 foi estimada para distinguir entre pacientes com demência e sujeitos controles.

Discussão:

O IFS-Ch mostra propriedades psicométricas aceitáveis, apoiadas por evidências de validade e confiabilidade para sua utilização como medida de funções executivas em pacientes com demência. Sua utilidade diagnóstica para detectar pacientes com demência também é considerada aceitável.

Palavras-chave:
INECO triagem frontal; funções executivas; testes neuropsicológicos; demência

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERENCES

Elliott R, Executive functions and their disorders. Br Med Bull 2003; 65:49-59.
Stuss DT, Levine B, Adult clinical neuropsychology: lessons from studies of the frontal lobes. Annu Rev Psychol 2002;53:401-433.
Verdejo A, Bechara A. Neuropsicología de las funciones ejecutivas. Psicothema 2010;22:227-235.
Chan RC, Shum D, Toulopoulou T, Chen EY. Assessment of executive functions: review of instruments and identification of critical issues. Arch Clin Neuropsychol 2008;23:201-216.
Miyake A, Emerson MJ, Friedman NP. Assessment of executive functions in clinical settings: problems and recommendations. Semin Speech Lang 2000;21:169-183.
Stuss DT, Alexander MP. Executive functions and the frontal lobes: a conceptual view. Psychol Res 2000;63:289-298.
Godefroy O. Frontal syndrome and disorders of executive functions. J Neurol 2003; 250: 1-6.
Voss SE, Bullock RA. Executive function: the core feature of dementia? Dement Geriatr Cogn Disord 2004;18:207-216.
Torralva T, Martínez M, Manes F. Demencia frontotemporal. In: Labos E, Slachevsky A, Fuentes P, Manes F (editors). Tratado de Neuropsicología Clínica. Buenos Aires, Argentiana: Librería Akadia; 2008:501-509.
Merino J, Hachinski V. Demencia Vascular. In: Labos E, Slachevsky A, Fuentes P, Manes F (editors). Tratado de Neuropsicología Clínica.Buenos Aires, Argentiana:Librería Akadia; 2008:511-519.
Graham NL, Emery T, Hodges JR. Distinctive cognitive profiles in Alzheimer's disease and subcortical vascular dementia. J NeurolNeurosurg Psychiatry 2004;75:61-71.
Cleusa P Ferri, Martin Prince, Carol Brayne, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112-2117.
Torralva T, Roca M, Gleichgerrcht E, López P, Manes F. INECO Frontal Screening (IFS): a brief, sensitive, and specific tool to assess executive functions in dementia. J Int Neuropsychol Soc 2009;15:777-786.
Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000;55:1621-1626.
Sarazin M, Pillon B, Giannakopoulos P, Rancurel G, Samson Y, Dubois B. Clinicometabolic dissociation of cognitive functions and social behavior in frontal lobe lesions. Neurology1998;51:142-148.
Lipton AM, Ohman KA, Womack KB, Hynan LS, Ninman ET, Lacritz LH. Subscores of the FAB differentiate frontotemporal lobar degeneration from AD. Neurology2005;65:726-731.
American Psychiatric Association. and American Psychiatric Association. Task Force on DSM-IV., Diagnostic and statistical manual of mental disorders : DSM-IV. 4th ed, Washington, DC: American pyschiatric association. 1994: xxvii, 886.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology1984;34:939-944.
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology1998; 51:1546-1554.
McKeith IG, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology1996;47:1113-1124.
Román GC, Tatemichi TK, Erkinjuntti T, et al., Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology1993;43:250-260.
Grant DA, Berg EA, A behavioural analysis of degree or reinforcement and ease of shifting to new responses in a Weigl-type card sorting problem. J Exp Psychology 1948; 38:404-411.
Berg EA. A simple objective technique for measuring flexibility in thinking. J Gen Psychol 1948;39:15-22.
Hodges JR. Cognitive assessment for clinicians. 2nd ed, Oxford ; New York: Oxford University Press. 2007:266, xviii
Nelson HE. A modified card sorting test sensitive to frontal lobe defects. Cortex 1976;12:313-324.
Henry JD, Crawford JR, A meta-analytic review of verbal fluency performance in patients with traumatic brain injury. Neuropsychology 2004; 18:621-628.
Benton A, Hamsher K. Multilingual aphasia examination manual, Iowa: Universidad de Iowa; 1976.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
Mangone C, Bauman D, Gigena V. Evaluación neuropsicológica de las demencias. In: Labos E, Slachevsky A, Fuentes P, Manes F (editors). Tratado de Neuropsicología Clínica. Buenos Aires, Argentiana: Librería Akadia; 2008:483-491.
Muñoz-Neira C, Henríquez Ch F, Ihnen J J, Sánchez C M, Flores M P, Slachevsky Ch A. Psychometric properties and diagnostic usefulness of the Addenbrooke's Cognitive Examination-revised in a Chilean elderly sample. Rev Med Chil 2012;140:1006-1013.
Wilson BA, Emslie H, Evans JJ, Alderman N, Burgess PW. Behavioural Assessment of the Dysexecutive Syndrome (BADS) Bury St. Edmunds: Thames Valley Test Company; 1996.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9: 179-186.
Muñoz-Neira C, López OL, Riveros R, Núñez-Huasaf J, Flores P, Slachevsky A. The technology - activities of daily living questionnaire: a version with a technology-related subscale. Dement Geriatr Cogn Disord 2012;33:361-371.
Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839-843.
Burgess PW, Alderman N, Evans J, Emslie H, Wilson B. The ecological validity of tests of executive function. J Int Neuropsychol Society 1998;4:547-558.
Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis. Cogn Psychol 2000;41:49-100.
Heaton RK, Grant I, Mathews C. Differences in neuropsychological test performances associated with age, education and sex. In: Grant I, Adams KM (Editors). Neuropsychological assessment in neuropsychiatric disorders. Oxford University Press: Nueva York; 1986:108-120.
Ivnik RJ, Malec JF, Smith GE, et al. Neuropsychological tests' norms above age 55: COWAT, BNT, MAE Token, WRAT-R Reading, AMNART, Stroop, TMT, and JLO. Clin Neuropsychologist 1996;10:262-278.
Mortiner JA, Graves AB, Education and other socioeconomic determinants of dementia and Alzheimer's Disease. Neurology1993;43:39-44.
Royall DR, Lauterbach EC, Cummings JL, et al., Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 2002;14:377-405.
Royall DR, Lauterbach EC, Kaufer D, Malloy P, Coburn KL, Black KJ, Committee on Research of the American Neuropsychiatric Association.The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci2007;19:249-265.
Godefroy O, Azouvi P, Robert P, Roussel M, LeGall D, Meulemans T; Groupe de Réflexion sur l'Evaluation des Fonctions Exécutives Study Group. Dysexecutive syndrome: diagnostic criteria and validation study. Ann Neurol 2010;68:855-864.
Manchester D, Priestley N, ackson H, The assessment of executive functions: coming out of the office. Brain Inj 2004;18:1067-1081.

Publication Dates

Publication in this collection
Jan-Mar 2013

History

Received
04 Nov 2012
Accepted
08 Jan 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Elliott R, Executive functions and their disorders. Br Med Bull 2003; 65:49-59.

[2] Stuss DT, Levine B, Adult clinical neuropsychology: lessons from studies of the frontal lobes. Annu Rev Psychol 2002;53:401-433.

[3] Verdejo A, Bechara A. Neuropsicología de las funciones ejecutivas. Psicothema 2010;22:227-235.

[4] Chan RC, Shum D, Toulopoulou T, Chen EY. Assessment of executive functions: review of instruments and identification of critical issues. Arch Clin Neuropsychol 2008;23:201-216.

[5] Miyake A, Emerson MJ, Friedman NP. Assessment of executive functions in clinical settings: problems and recommendations. Semin Speech Lang 2000;21:169-183.

[6] Stuss DT, Alexander MP. Executive functions and the frontal lobes: a conceptual view. Psychol Res 2000;63:289-298.

[7] Godefroy O. Frontal syndrome and disorders of executive functions. J Neurol 2003; 250: 1-6.

[8] Voss SE, Bullock RA. Executive function: the core feature of dementia? Dement Geriatr Cogn Disord 2004;18:207-216.

[9] Torralva T, Martínez M, Manes F. Demencia frontotemporal. In: Labos E, Slachevsky A, Fuentes P, Manes F (editors). Tratado de Neuropsicología Clínica. Buenos Aires, Argentiana: Librería Akadia; 2008:501-509.

[10] Merino J, Hachinski V. Demencia Vascular. In: Labos E, Slachevsky A, Fuentes P, Manes F (editors). Tratado de Neuropsicología Clínica.Buenos Aires, Argentiana:Librería Akadia; 2008:511-519.

[11] Graham NL, Emery T, Hodges JR. Distinctive cognitive profiles in Alzheimer's disease and subcortical vascular dementia. J NeurolNeurosurg Psychiatry 2004;75:61-71.

[12] Cleusa P Ferri, Martin Prince, Carol Brayne, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112-2117.

[13] Torralva T, Roca M, Gleichgerrcht E, López P, Manes F. INECO Frontal Screening (IFS): a brief, sensitive, and specific tool to assess executive functions in dementia. J Int Neuropsychol Soc 2009;15:777-786.

[14] Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000;55:1621-1626.

[15] Sarazin M, Pillon B, Giannakopoulos P, Rancurel G, Samson Y, Dubois B. Clinicometabolic dissociation of cognitive functions and social behavior in frontal lobe lesions. Neurology1998;51:142-148.

[16] Lipton AM, Ohman KA, Womack KB, Hynan LS, Ninman ET, Lacritz LH. Subscores of the FAB differentiate frontotemporal lobar degeneration from AD. Neurology2005;65:726-731.

[17] American Psychiatric Association. and American Psychiatric Association. Task Force on DSM-IV., Diagnostic and statistical manual of mental disorders : DSM-IV. 4th ed, Washington, DC: American pyschiatric association. 1994: xxvii, 886.

[18] McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology1984;34:939-944.

[19] Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology1998; 51:1546-1554.

[20] McKeith IG, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology1996;47:1113-1124.

[21] Román GC, Tatemichi TK, Erkinjuntti T, et al., Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology1993;43:250-260.

[22] Grant DA, Berg EA, A behavioural analysis of degree or reinforcement and ease of shifting to new responses in a Weigl-type card sorting problem. J Exp Psychology 1948; 38:404-411.

[23] Berg EA. A simple objective technique for measuring flexibility in thinking. J Gen Psychol 1948;39:15-22.

[24] Hodges JR. Cognitive assessment for clinicians. 2nd ed, Oxford ; New York: Oxford University Press. 2007:266, xviii

[25] Nelson HE. A modified card sorting test sensitive to frontal lobe defects. Cortex 1976;12:313-324.

[26] Henry JD, Crawford JR, A meta-analytic review of verbal fluency performance in patients with traumatic brain injury. Neuropsychology 2004; 18:621-628.

[27] Benton A, Hamsher K. Multilingual aphasia examination manual, Iowa: Universidad de Iowa; 1976.

[28] Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[29] Mangone C, Bauman D, Gigena V. Evaluación neuropsicológica de las demencias. In: Labos E, Slachevsky A, Fuentes P, Manes F (editors). Tratado de Neuropsicología Clínica. Buenos Aires, Argentiana: Librería Akadia; 2008:483-491.

[30] Muñoz-Neira C, Henríquez Ch F, Ihnen J J, Sánchez C M, Flores M P, Slachevsky Ch A. Psychometric properties and diagnostic usefulness of the Addenbrooke's Cognitive Examination-revised in a Chilean elderly sample. Rev Med Chil 2012;140:1006-1013.

[31] Wilson BA, Emslie H, Evans JJ, Alderman N, Burgess PW. Behavioural Assessment of the Dysexecutive Syndrome (BADS) Bury St. Edmunds: Thames Valley Test Company; 1996.

[32] Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[33] Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9: 179-186.

[34] Muñoz-Neira C, López OL, Riveros R, Núñez-Huasaf J, Flores P, Slachevsky A. The technology - activities of daily living questionnaire: a version with a technology-related subscale. Dement Geriatr Cogn Disord 2012;33:361-371.

[35] Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839-843.

[36] Burgess PW, Alderman N, Evans J, Emslie H, Wilson B. The ecological validity of tests of executive function. J Int Neuropsychol Society 1998;4:547-558.

[37] Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis. Cogn Psychol 2000;41:49-100.

[38] Heaton RK, Grant I, Mathews C. Differences in neuropsychological test performances associated with age, education and sex. In: Grant I, Adams KM (Editors). Neuropsychological assessment in neuropsychiatric disorders. Oxford University Press: Nueva York; 1986:108-120.

[39] Ivnik RJ, Malec JF, Smith GE, et al. Neuropsychological tests' norms above age 55: COWAT, BNT, MAE Token, WRAT-R Reading, AMNART, Stroop, TMT, and JLO. Clin Neuropsychologist 1996;10:262-278.

[40] Mortiner JA, Graves AB, Education and other socioeconomic determinants of dementia and Alzheimer's Disease. Neurology1993;43:39-44.

[41] Royall DR, Lauterbach EC, Cummings JL, et al., Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 2002;14:377-405.

[42] Royall DR, Lauterbach EC, Kaufer D, Malloy P, Coburn KL, Black KJ, Committee on Research of the American Neuropsychiatric Association.The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci2007;19:249-265.

[43] Godefroy O, Azouvi P, Robert P, Roussel M, LeGall D, Meulemans T; Groupe de Réflexion sur l'Evaluation des Fonctions Exécutives Study Group. Dysexecutive syndrome: diagnostic criteria and validation study. Ann Neurol 2010;68:855-864.

[44] Manchester D, Priestley N, ackson H, The assessment of executive functions: coming out of the office. Brain Inj 2004;18:1067-1081.

Brasil