Exploración de las propiedades psicométricas de la Batería Montreal de Evaluación de Amusia en una muestra de sujetos con epilepsia de lóbulo temporal / Exploration of the psychometric properties of the Montreal Battery of Evaluation of Amusia in a sample with temporal lobe epilepsy

ANTECEDENTES: La Batería Montreal de Evaluación de Amusia (MBEA) es un instrumento de reciente creación, utilizado para evaluar percepción y memoria musical asociadas al funcionamiento de lóbulos temporales. La epilepsia de lóbulo temporal no sintomática (ELTns) es una condición de alta prevalencia en México; esto proporciona una oportunidad para evaluar la MBEA, considerando que las crisis epilépticas pueden producir alteraciones neuropsicológicas específicas según la localización lobular y la lateralización de foco epileptogénico (LFE). OBJETIVO: Explorar las propiedades psicométricas y diagnósticas de la MBEA. MÉTODO: Dos muestras no probabilística de 31 controles y 22 casos de epilepsia ELTns fueron evaluados con la MBEA. Se utilizaron asimismo los datos estandarizados originales de la MBEA para comparación de controles. RESULTADOS: El análisis con prueba t mostró desempeños significativamente menores de los casos en comparación con los controles y significativamente menores entre controles y la norma. No se encontraron diferencias significativas en los puntajes según LFE. El análisis por Curvas ROC mostró propiedades cuestionables de sensibilidad y especificidad en la MBEA utilizando la ELTns como variable de estado. DISCUSIÓN Y CONCLUSIÓN: Se hallaron alteraciones en funciones de percepción musical en los casos; sin embargo, se detectaron inconsistencias teóricas con respecto a la relación de funciones afectadas. Las diferencias entre el grupo control y la norma apuntan a continuar evaluando la MBEA en población mexicana. La MBEA parece ser una medida poco precisa en términos de sensibilidad y especificidad para las alteraciones amúsicas en la ELTns, y su utilidad como medida de apoyo en la determinación de LFE permanece incierta.

BACKGROUND: The Montreal Battery of Evaluation of Amusia (MBEA) is a newly developed instrument to assess music perception and memory, associated to temporal lobe functioning. The non-symptomatic temporal lobe epilepsy is a prevalent condition in Mexico, and it gives an opportunity to test the MBEA, considering the fact that epileptic seizures can cause neuropsychological impairment according to lobar localization and hemispherical lateralization of the epileptogenic foci. OBJECTIVE: To explore the psychometric and diagnostic properties of the MBEA. METHOD: Two non-probabilistic samples of 31 control subjects and 22 cases with non-symptomatic temporal lobe epilepsy were assessed with the MBEA. Data from the original validation were used to compare with the control group. RESULTS: Analysis with t test showed significantly lower performances in the case group relative to controls, and a general lower performance of controls compared to the norm. There was no significant difference in performance between cases with left epileptogenic foci and cases with right epileptogenic foci. ROC curve analysis showed questionable properties of sensitivity and specificity in the MBEA. DISCUSSION AND CONCLUSION: Impairments in music perception were found in cases, although theoretical inconsistences with respect to relation between impaired functions were also detected. The performance of the control group relative to the norm aims to the continuation of the validation process, considering cultural differences. The MBEA seems to be a poor measure in terms of sensibility and specificity for the detection of amusic impairments in subjects with non-symptomatic temporal lobe epilepsy, and its utility for determining hemispheric lateralization of epileptogenic foci remains uncertain.

Propuesta de evaluación neuropsicológica para casos donde exista una alteración en la percepción musical / A proposal for neuropsychological evaluation in cases where there is an alteration in musical perception

Existen diferentes condiciones que no se consideran tan relevantes, debido a que no son totalmente incapacitantes. Aun así cuando un paciente considera importante un síntoma o una condición específica, esta debe tomarse con seriedad, ya que es posible que sea una parte esencial de aquella persona. La música se considera como uno de los mayores reforzadores para el ser humano, así como una gran herramienta para la estimulación neuropsicológica. Sin embargo, poco se ha investigado en relación con este tema, razón por la que se recomienda integrar el área musical como parte de la evaluación e intervención neuropsicológica. Este artículo tiene como objetivo construir una propuesta de evaluación neuropsicológica para casos donde exista una alteración en la percepción musical. A través de un estudio de caso único, y a partir de un protocolo estándar de evaluación neuropsicológica, junto con pruebas adicionales específicas sobre música, se finaliza con una propuesta que incluye diagnósticos diferenciales como depresión, amusia y anhedonia musical. Como aportes, se establece que es una propuesta que, además de novedosa, se ha de tener en cuenta debido a la relevancia que implica el componente musical. Asimismo, se destaca la idea de evaluar al paciente de forma integral, no solo sobre su estado cognitivo general, sino además emocional, siempre teniendo en cuenta lo que el paciente precisa.

There are different conditions which are not considered as relevant because they are not totally disabling. Yet when a patient regards a symptom or a specific condition as important, it should be taken seriously, because it may be an essential part of that person. Music is considered as one of the biggest reinforcers for humans, as well as a great tool for neuropsychological stimulation. But little has been investigated in relation to this issue. It is recommended to integrate the musical area as part of the neuropsychological evaluation and intervention. This article aims to build a proposed neuropsychological assessment for cases where there is an alteration in the perception of music. Through a single case study, and from a standard neuropsychological assessment protocol, along with specific additional evidence about music, it ends with a proposal that includes differential diagnoses such as depression, musical anhedonia and amusia. As a contribution states that it is a proposal that, in addition to novelty, it should be taken into account due to the relevance that involves the musical component; and the fact that assess the patient holistically, not only on their overall cognitive state but also emotional and always taking into account what the patient needs.

Trastornos de la percepción musical / Musical perception disorders

La percepción musical es una experiencia que no sólo involucra componentes cognitivos, sino también respuestas emocionales acorde a la experiencia y cultura del sujeto. El procesamiento musical se inicia a nivel periférico en el sistema auditivo, y a nivel central se divide en diferentes regiones cerebrales que se ocupan del análisis de la organización melódica y temporal, además del análisis del repertorio. Por lo tanto, es necesaria una gran red neuronal córtico-subcortical ascendente y descendente, entre ambos hemisferios y además conexiones hacia el cerebelo, que permiten la creación de la percepción musical. Los trastornos de la percepción musical se pueden clasificar a grandes rasgos, en amusia y alucinaciones musicales. La amusia, en términos generales, es la pérdida específica de la percepción musical, que puede ser congénita o adquirida. Un grupo creciente de pacientes con amusia adquirida son la mayoría de los usuarios de implante coclear. Por otro lado, las alucinaciones musicales son descripciones verbales de experiencias sensoriales acústicas de tipo musical que no están explicadas por un estímulo externo y están presentes en pacientes con patología neurológica y psiquiátrica, pero también en personas con sordera profunda bilateral. Actualmente, existen disponibles algunos instrumentos para evaluar las alteraciones de la percepción musical, siendo la batería de Montreal para la evaluación de amusia, una de las pruebas musicales más utilizadas que permite estimar las habilidades perceptuales y de memoria en adultos y recientemente también en niños. Los trastornos de la percepción musical son patologías emergentes con impacto en la calidad de vida de los pacientes.

Music perception is an experience that involves cognitive and emotional sensations according to the cultural background of the subject. The musical processing begins at the periphery in the auditory system and then in the central level is divided in melodic and temporal processing including the musical repertory. An extensive cortical and subcortical neuronal network is needed for the creation of the musical experience including ascending and descending pathways, both cerebral hemispheres and the cerebellum. Musical perception disorders can be classified in two main groups; amusia and musical hallucinations. Amusia corresponds to the inability to recognize musical tones that can be congenital or acquired. A growing group of acquired amusia patients is the majority of cochlear implant users. On the other hand musical hallucinations are the perception of music without an external stimulus, which can be produced by neurologic and psychiatric states, but also in persons with profound bilateral deafness. Nowadays the Montreal battery of evaluation of amusia is available to evaluate the perceptual skills and memory in adults and child; this test allows the detection of musical perception disorders that are seen as an emerging group of diseases with an important impact in life quality of our patients.

Amusias and modularity of musical cognitive processing

In the past few years the study of music from a neuroscientific perspective has considerably improved, allowing the evolution of both theoretical knowledge and constructs related to cognitive musical processing. Both neuroimaging studies and studies of individuals who suffer from selective deficits of musical abilities have favored the construction of useful models to understand the mechanisms of musical processing, thus revealing its complexity and eliciting the hypothesis of the modular organization of music in the brain. This article reviews studies of cognitive musical processing with a focus on deficits in musical abilities and the neuropsychological model of cognitive musical processing developed by Isabelle Peretz. This model is an important contribution to neuroscientific studies of music because it furthers the understanding of selective deficits in different components of musical processing that occur in both individuals who incur brain damage and those with congenital amusia. The model also serves as theoretical support for diagnosing different types of amusia.

Tradução e validação de conteúdo de uma bateria de testes para avaliação de amusia / Translation and content validation of a battery of tests to evaluate amusia

Este estudo objetivou realizar a adaptação cultural da Montreal Battery of Evaluation of Amusia - MBEA, que se constitui em uma bateria de testes que avalia funções musicais, visando sua adaptação para a população de adolescentes brasileiros. Foram realizadas três etapas: equivalência conceitual, equivalência de itens e equivalência semântica. Participaram deste estudo 20 juízes não-especialistas e 6 juízes especialistas, responsáveis por avaliar os itens da MBEA e seus construtos. Na análise de conteúdo, obtiveram-se altos índices de concordância entre os juízes, exceto para os construtos escala e intervalo. Pelos grupos focais, observou-se que os adolescentes associaram os itens à música erudita, mas isto não afetou sua compreensão do teste. Quanto à equivalência cultural, 70 por cento dos itens apresentaram altos índices de concordância entre juízes. Na equivalência semântica não se apresentaram diferenças significativas entre as retraduções e a versão original. Concluiu-se ser adequado manter os itens originais do teste, pois, além de compreensíveis para a população-alvo, são compostos dentro do sistema tonal ocidental, o qual é utilizado em ambas as culturas.

This study aimed to perform a cultural adaptation of the Montreal Battery of Evaluation of Amusia - MBEA, which constitutes a battery of tests that evaluates musical functions, in order to adapt them to the population of Brazilian adolescents. Research was conducted in three stages: conceptual equivalence, items equivalence and semantic equivalence. The study included 20 non-expert judges and 6 expert judges, responsible for assessing the items of MBEA and their constructs. In the analysis of content, there were high rates of agreement among the judges, except for the constructs of scale and intervals. Considering focus groups, it was observed that adolescents associated the items with classical music, but this did not affect their understanding of the test. Concerning cultural equivalence, 70 percent of the items had high rates of agreement among judges. Regarding semantic equivalence, there were no significant differences between the back translation and the original version. We conclude to be appropriate to maintain the original items of the test because, in addition to being comprehensible to the target population, they are made within the Western tonal system, which is used in both cultures.