Validez del cuestionario PHQ-2 para la detección de depresión en personal sanitario colombiano durante Covid-19 / Validity of the PHQ-2 questionnaire for the detection of depression in Colombian health personnel during Covid-19

RESUMEN: Introducción: La sintomatologia depresiva en profesionales de la salud asociado a crisis virales es de alta prevalencia a nivel global, siendo su detección una prioridad por lo cual, el objetivo de esta investigación fue analizar la validez convergente y consistencia interna del cuestionario de salud del paciente-2 (PHQ-2) en profesionales sanitarios. Método: Estudio eSalud donde se recopilaron datos transversales en línea (n=725), de 281 médicos generales, 237 médicos especialistas y 207 enfermeras durante la cuarentena colombiana, entre el 20 de abril y el 10 de agosto de 2020. Edad promedio 41,3 años (± 8,76). El 38,4% eran hombres (278) y el 61.6% mujeres (447). El 66.1% del personal sanitario atendió pacientes contagiados por coronavirus y el 33,9% no prestó estos servicios. Se administró la versión de 9 ítems del PHQ, validada en población colombiana junto a la versión de 2 ítems del PHQ. Resultados: Se encontró una alta correlación entre las escalas (r=.860, P<0.001), demostrando la validez convergente del PHQ-2 para medir la sintomatología depresiva. La consistencia interna del PHQ-2 fue adecuada, con un Alpha de Cronbach de 0.80 (I.C.= 0.76 - 0.83). Conclusiones: El PHQ-2 presenta adecuados estándares psicométricos de confiabilidad y validez, por lo que su rápida administración, fácil calificación e interpretación, lo convierte en un instrumento confiable y valido para la detección rápida, sin sobrecargas laborales, de los síntomas depresivos en médicos y enfermeras que atiendan o no pacientes en condiciones de brotes virales.

ABSTRACT Background: Depressive symptomatology in health professionals associated with viral crises is highly prevalent globally, being its detection a priority. Therefore, the objective of this research was to analyze the convergent validity and internal consistency of the Patient Health Questionnaire (PHQ-2) in healthcare professionals. Method: E-Health study where cross-sectional data was collected online (n = 725), from 281 general practitioners, 237 specialist doctors and 207 nurses during the Colombian quarantine, between April 20 and August 10, 2020. Average age 41.3 years (± 8.76). 38.4% were men (278) and 61.6% women (447). 66.1% of health personnel treated patients infected with coronavirus and 33.9% did not provide these services. The 9-item version of the PHQ was administered, validated in the Colombian population together with the 2-item version of the PHQ. Results: A high correlation was found between the scales (r = .860, P <0.001), demonstrating the convergent validity of the PHQ-2 to measure depressive symptomatology. The internal consistency of the PHQ-2 was adequate, with a Cronbach's Alpha of 0.80 (I.C. = 0.76 - 0.83). Conclusions: The PHQ-2 has adequate psychometric standards of reliability and validity, so its rapid administration, easy qualification and interpretation, makes it a reliable and valid instrument for the rapid detection, without work overload, of depressive symptoms in doctors and nurses whether or not they care for patients with viral outbreaks.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults / Utilidade clínica do phototest via teleneuropsicologia em idosos rurais chilenos

ABSTRACT. The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

RESUMO. A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.

Diferencias en tareas de función ejecutiva entre adolescentes y adultos mayores bilingües y monolingües / Differences in Executive Function between Bilingual and Monolingual Teenagers and Older Adults

Resumen Nos propusimos comparar el rendimiento en tareas de función ejecutiva entre adolescentes y adultos mayores bilingües y monolingües. Utilizamos un diseño comparativo transversal. Evaluamos a 48 personas monolingües (24 adolescentes y 24 adultos mayores) y 56 bilingües (31 adolescentes y 25 adultos mayores) con una amplia batería neuropsicológica que comprendían tareas de flexibilidad cognitiva (Wisconsin Card Sorting Test), control inhibitorio (test de Stroop), memoria de trabajo (subescalas de Retención de dígitos, Secuencia de números y letras: test Wechsler de inteligencia) y acceso a la memoria a largo plazo (fluidez semántica y fonológica). Nuestros resultados indican que los adolescentes y adultos mayores monolingües rinden mejor en las pruebas de control ejecutivo que sus pares bilingües, siendo estas diferencias menores en los adultos mayores y no parecen asociarse a la edad y a la frecuencia de uso de L1 (castellano) y L2 (quechua). Estos resultados muestran que durante la adolescencia hay una desventaja a nivel ejecutivo en las personas bilingües, la cual parece disminuir en la adultez. Se discuten los resultados a la luz del peso de los factores socioculturales y a la posibilidad de entender al bilingüismo como un mecanismo ligado a la reserva cognitiva.

Abstract Our purpose was to compare performance in executive function tasks between bilingual and monolingual adolescents and older adults. A cross-sectional design was used. We evaluated 48 monolinguals (24 adolescents and 24 older adults) and 56 bilinguals (31 adolescents and 25 older adults) with a wide neuropsychological battery that included tasks of cognitive flexibility (Wisconsin card sorting test), inhibitory control (Stroop test), working memory (direct and inverse digits) and access to long-term memory (semantic and phonological fluency). Our results indicate that monolingual adolescents and older adults perform better in executive control tests than their bilingual counterparts, and these differences are minor in bilingual older adults, these differences do not seem to be associated with age and the frequency of use of L1 (Spanish) and L2 (Quechua). These results seem to show that during adolescence there is a cognitive disadvantage in executive function, which is reduced when people get older. The results are discussed considering sociocultural factors and the possibility of understanding bilingualism as a mechanism linked to cognitive reserve.

Neuropsychological profile in the preclinical stages of dementia: principal component analysis approach / Perfil neuropsicológico nos estágios pré-clínicos de demência: abordagem por análise de componente principal

ABSTRACT. The preclinical stages of dementia include subtle neurocognitive changes that are not easily detected in standard clinical evaluations. Neuropsychological evaluation is important for the classification and prediction of deterioration in all the phases of dementia. Objective: Compare the neuropsychological performance in healthy older adults with subjective cognitive decline (SCD) and with mild cognitive impairment (MCI) using principal components analysis. Methods: We evaluated 94 older adults with a clinical protocol which included general measures of mental, emotional and functional state. The neuropsychological protocol included tasks of memory, executive function, attention, verbal fluency and visuoconstructional abilities. We used principal component analysis (PCA) to reduce variables´ dimensionality on neuropsychological evaluation. Results: 33(35%) participants had a normal cognitive function, 35(37%) had subjective cognitive decline and 26(28%) had a mild cognitive impairment. The PCA showed seven factors: processing speed, memory, visuoconstruction, verbal fluency and executive components of cognitive flexibility, inhibitory control and working memory. ANOVA had shown significant differences between the groups in the memory (F=4.383, p=0.016, η2p=0.087) and visuoconstructional components (F=5.395, p=0.006, η2p=0.105). Post hoc analysis revealed lower memory scores in MCI than SCD participants and in visuospatial abilities between MCI and SCD and MCI and Normal participants. Conclusions: We observed differentiated cognitive profiles among the participants in memory and visuoconstruction components. The use of PCA in the neuropsychological evaluation could help to make a differentiation of cognitive abilities in preclinical stages of dementia.

RESUMO. Os estágios pré-clínicos da demência incluem mudanças neurocognitivas sutis que não são facilmente detectadas nas avaliações clínicas padrão. A avaliação neuropsicológica é importante para a classificação e predição da deterioração em todas as fases da demência. Objetivo: Comparar o desempenho neuropsicológico em idosos saudáveis com declínio cognitivo subjetivo (DCS) e com comprometimento cognitivo leve (CCL) por meio da análise de componentes principais. Métodos: Avaliaram-se 94 idosos com um protocolo clínico que incluía medidas gerais do estado mental, emocional e funcional. O protocolo neuropsicológico incluiu tarefas de memória, função executiva, atenção, fluência verbal e habilidades visuoconstrutivas. Utilizou-se a análise de componentes principais (PCA, na sigla em inglês) para reduzir a dimensionalidade das variáveis na avaliação neuropsicológica. Resultados: Um total de 33 (35%) participantes apresentavam função cognitiva normal, 35 (37%) declínio cognitivo subjetivo e 26 (28%) comprometimento cognitivo leve. A PCA apresentou sete fatores: velocidade de processamento, memória, visuoconstrução, fluência verbal e componentes executivos de flexibilidade cognitiva, controle inibitório e memória de trabalho. ANOVA mostrou diferenças significativas entre os grupos na memória (F=4,383, p=0,016, η2p=0,087) e componentes visuoconstrutivos (F=5,395, p=0,006, η2p=0,105). A análise post hoc revelou escores de memória mais baixos no CCL do que os participantes com DCS e nas habilidades visuoespaciais entre CCL e DCS e CCL e participantes normais. Conclusões: Observaram-se perfis cognitivos diferenciados entre os participantes nos componentes de memória e visuoconstrução. O uso da PCA na avaliação neuropsicológica poderia auxiliar na diferenciação das habilidades cognitivas em estágios pré-clínicos da demência.

Comparison of the cognitive profile in patients with alcoholism and schizophrenia

Resumen Introducción: Estudios recientes muestran que una alta prevalencia de trastornos psicóticos y por consumo de sustancias comparten mecanismos cerebrales comunes que pueden afectar el rendimiento cognitivo, la adhesión al tratamiento y, con ello, aumentar el riesgo de recaídas. Objetivo: Comparar el rendimiento cognitivo en pacientes con alcoholismo y con esquizofrenia. Material y Métodos: Estudio observacional que evaluó a 18 pacientes con esquizofrenia y 32 con trastorno mental debido a consumo de alcohol. Se utilizó la batería neuropsicológica breve NEUROPSI, validada en español. Resultados: Se encontraron diferencias significativas entre ambos grupos en áreas de función ejecutiva y memoria declarativa (a largo plazo), con mayores puntajes de deterioro en el grupo de pacientes con esquizofrenia. Conclusiones: Los resultados permiten comprender y explicar las dificultades observadas en pacientes con esquizofrenia en cuanto a funciones de regulación conductual y recuperación de información.

Summary Introduction: Recent studies report a high prevalence of psychotic and substance use disorders sharing common brain mechanisms that may affect cognitive performance, response to treatment, the ability to commit to it and, consequently, increase the risk of relapse. Objective: To compare cognitive performance in patients with alcoholism and schizophrenia. Material and Methods: Observational study designed to evaluated 18 patients with schizophrenia and 32 with mental disorders due to alcohol consumption. The short neuropsychological battery NEUROPSI, validated in Spanish, was the main study instrument. Results: Significant differences were found between both groups in areas of executive function and long-term memory, with the sub-group of patients with schizophrenia showing greater deterioration levels. Conclusion: The results assist in explaining and understanding the difficulties that patients with schizophrenia experience in the functions of behavior regulation and information retrieval.

Afectación Neuropsicológica de la Función Ejecutiva en Pacientes con Insuficiencia Renal Crónica / Neuropsychological Impairment of Executive Function in Patients with Chronic Renal Failure

Resumen Objetivos: Analizar las diferencias en el rendimiento neuropsicológico de las funciones ejecutivas en pacientes tratados con Diálisis Peritoneal (DP) y Hemodiálisis (HD), además de valorar el nivel de afectación de las modalidades de tratamiento (DP vs HD) y las variables demográficas y clínicas sobre la respuesta cognitiva. Método: Estudio de corte transversal con muestreo no probabilístico que incluyó a 40 pacientes con insuficiencia renal crónica (IRC), divididos en dos grupos: 20 pacientes sometidos a DP y 20 a HD. Se utilizó una batería de pruebas neuropsicológicas que incluyeron El Test de Palabras y Colores de STROOP, la parte B del Trail Making Test (TMT), la Torre de Hanoi y el subtest de Dígitos Inversos de la Escala Wechsler; además de un cuestionario sobre variables clínicas y demográficas. Resultados: Se evidenciaron diferencias significativas en el número de errores del TMT B y el número de movimientos de la Torre de Hanoi, siendo los pacientes sometidos a DP quienes rindieron mejor que los pacientes sometidos a HD. Por otra parte, los años de escolaridad y la edad de los pacientes parecen tener un efecto significativo sobre el rendimiento en las pruebas neuropsicológicas utilizadas. Conclusiones: Los pacientes sometidos a DP tienen un mejor rendimiento en pruebas de función ejecutiva, pero dicho rendimiento es modulado por los años de escolaridad y la edad. Se discute el papel de la escolarización y la edad sobre el rendimiento neuropsicológico y las posibles causas de las diferencias encontradas en los grupos evaluados.

Abstract Objectives: Analyze differences in neuropsychological performance of executive functions in patients treated with peritoneal dialysis (PD) and hemodialysis (HD), and to assess the level of impact of treatment modalities (HD vs PD) and the demographic and clinical variables over cognitive function. Materials and methods: Cross-sectional study with non-probability sampling that included 40 patients with chronic renal failure (CRF) divided into two groups, 20 patients undergoing peritoneal dialysis and 20 in hemodialysis. It was used a battery of neuropsychological tests including test Stroop words and colors, Part B of the Trail Making Test (TMT), Tower of Hanoi, and indirect Digit subtest of the Wechsler scale; and a questionnaire on demographic and clinical variables. Results: Significant differences were found in the number of errors of TMT B and the number of movements of the Tower of Hanoi, with the PD patients who performed better than patients undergoing HD. Moreover, years of schooling and the age of patients appear to have a significant effect on performance in the neuropsychological tests used. Conclusions: Patients undergoing peritoneal dialysis have better performance on executive function tests, but this performance is modulated by the years of schooling and age. It is discussed the role of schooling and age on neuropsychological performance and possible causes of the differences in the evaluated groups.

Indicadores de sensibilidad y especificidad para dos puntos de corte del Mini Mental State Examination: Estudio preliminar / Sensibility and specificity indicators for two cut-off points of the Mini Mental State Examination: A preliminary study

Objetivos: Comparar los indicadores de sensibilidad y especificidad para dos puntos de corte según las adaptaciones del Mini-Mental State Examination (MMSE) efectuadas en el Perú. Material y Métodos: Estudio en primera fase de validación prospectiva. Se evaluaron 656 adultos de ambos sexos, mayores de 55 años, integrantes de clubes del adulto mayor y de la Asociación Peruana de Enfermedad de Alzheimer, filial Arequipa, durante los años 2014 y 2015.Se utilizó la versión adaptada del MMSE y se recabaron datos sobre el nivel funcional de los participantes. Resultados: El mayor nivel de sensibilidad y especificidad fue encontrado en el punto de corte de 20 puntos, propuesto para el grupo entre 0 y 3 años de escolaridad; dichos indicadores van disminuyendo conforme aumenta la escolaridad. Conclusiones: El MMSE muestra mejores indicadores de sensibilidad y especificidad cuando se ajusta las puntuaciones en base a los años de escolaridad. Es necesario profundizar en el análisis y seguimiento de los casos y considerar evaluaciones más extensas y complejas de posibles niveles de deterioro cognitivo.

Objectives: To compare the sensitivity and specificity indicators for two cutoff points according to adaptations of the Mini-Mental State Examination (MMSE) made in Perú. Methods: First stage prospective validation study. A sample of 656 adults, 55 years or older and from both genders, members of elderly clubs and of the Peruvian Association of Alzheimer's Disease in Arequipa, were evaluatedbetween 2015 and 2016. The adapted version of the MMSE was used and data on the participants' functional level was collected. Results: The higher level of sensitivity and specificity was of 20 as a cutoff point for the group between 0 and 3 years of schooling;this indicator decreased as the schooling level advanced. Conclusions: The MMSE shows better sensitivity and specificity indicators when the score is adjusted in accordance to school years. However, it is necessary to deepen the analysis and follow-up of the cases, as well as to consider more extensive and complex assessments of eventual levels of cognitive impairment.

Funciones ejecutivas en adultos mayores alfabetizados y no alfabetizados / Executive function in literate and illiterate older subjects

El estudio de las funciones cognitivas, sobre todo de las funciones ejecutivas, en poblaciones envejecidas analfabetas y con bajo nivel educativo no ha recibido la atención necesaria. Los estudios muestran un incremento significativo en la probabilidad de desarrollar deterioro cognitivo e inclusive demencia en poblaciones con bajo nivel educativo y/o analfabetas, este aumento de casos estaría asociado a la poca capacidad de afrontamiento cerebral y cognitivo observado en procesos neurodegenerativos y que estaría mediado por procesos educativos formales. Nos hemos propuesto comparar el rendimiento en funciones ejecutivas en poblaciones alfabetizadas y no alfabetizadas adultas mayores. Para esto se evaluó a un total de 156 adultos mayores divididos en cuatro grupos: analfabetos, con educación primaria, secundaria y superior. Se utilizo el frontal assesment battery (FAB). Nuestros resultados muestran diferencias significativas entre los sujetos alfabetizados y no alfabetizados en aquellas variables mediadas por aspectos verbales y por mecanismos regulatorios inhibitorios; observamos además que los sujetos analfabetos y de educación primaria se diferencian significativamente de sujetos con educación secundaria y superior. Estas primeras aproximaciones nos muestran el peso que la escolarización formal tiene sobre la arquitectura cerebral y funcional, además abre una línea de investigación prometedora que analice el papel de la función ejecutiva en el envejecimiento cognitivo normal y patológico como base de los mecanismos compensatorios cognitivos y cerebrales.

The study of cognitive functions in ageing, especially the executive functions in illiterate populations have not received the necessary attention. Studies show a significant increase of risk to develop cognitive impairment or dementia in populations with low level of education and/or illiterate. This increase of cases would be associated with the low capacity of brain and cognition to cope with neurodegenerative processes and which would be mediated by formal educational process. The aim of the study is compare the performance in executive functions in literate and illiterates. A total of 156 older adults were divided into four groups according to educational level: illiterates; subjects with basic and high school and subjects with university degree with the frontal assessment battery (FAB). Our results show significant differences between literates and illiterates in those variables mediated by verbal aspects and inhibitory control mechanisms. We also note that illiterate subjects and with basic school level are significantly different from subjects with higher school level and with university education. These first approximations show us the importance that formal schooling has on brain and functional architecture and opens up a line of promising research that analyzes the role of the executive function in normal and pathological cognitive ageing.