Identification of Neuropsychiatric Symptoms in Preclinical and Prodromal Stages in Dementias: Development of a Screening Test for Mild Behavioral Impairment.

BACKGROUND: Neuropsychiatric symptoms (NPS) are a psychopathological dimension of neurodegenerative diseases, consisting of personality changes, behavioral disorders, and alterations in basic functions such as appetite or sleep, among others. The aim of this study was the construction and validation of a screening test to identify these NPS associated with neurodegenerative pathologies in preclinical and prodromal stages, based on the ISTAART criteria for Mild Behavioral Impairment (MBI). METHOD: The sample consisted of 206 subjects over 55 years old (117 cognitively healthy, 89 with Mild Cognitive Impairment). 69% were women, the mean age was 77 years ( SD = 10.58). RESULTS: The new scale consists of 19 items and exhibited a one-dimensional structure. Confidence was excellent (α = .94 and Ω = .97) and there was evidence of convergent validity with the MBI-C test ( r = .88) and the NPI-Q ( r = .82). In addition, the scale demonstrated good sensitivity (.88) and specificity (.80). CONCLUSIONS: The scale allows evaluation of NPS in DCoL. It exhibits good psychometric properties and makes a useful tool in early diagnosis of neurodegenerative pathologies.

Identification of Neuropsychiatric Symptoms in Preclinical and Prodromal Stages in Dementias: Development of a Screening Test for Mild Behavioral Impairment / Identificación de los Síntomas Neuropsiquiátricos en Fases Preclínicas y Prodrómicas en Demencias: Desarrollo de un Test de Cribado para el Deterioro Conductual Leve

Background: Neuropsychiatric symptoms (NPS) are a psychopathological dimension of neurodegenerative diseases, consisting of personality changes, behavioral disorders, and alterations in basic functions such as appetite or sleep, among others. The aim of this study was the construction and validation of a screening test to identify these NPS associated with neurodegenerative pathologies in preclinical and prodromal stages, based on the ISTAART criteria for Mild Behavioral Impairment (MBI). Method: The sample consisted of 206 subjects over 55 years old (117 cognitively healthy, 89 with Mild Cognitive Impairment). 69% were women, the mean age was 77 years (SD = 10.58). Results: The new scale consists of 19 items and exhibited a one-dimensional structure. Confidence was excellent (α = .94 and Ω = .97) and there was evidence of convergent validity with the MBI-C test (r = .88) and the NPI-Q (r = .82). In addition, the scale demonstrated good sensitivity (.88) and specificity (.80). Conclusions: The scale allows evaluation of NPS in DCoL. It exhibits good psychometric properties and makes a useful tool in early diagnosis of neurodegenerative pathologies.(AU)

Antecedentes: Los síntomas neuropsiquiátricos (SNP) constituyen una dimensión psicopatológica de las enfermedades neurodegenerativas conformada por cambios en la personalidad, trastornos conductuales o alteraciones en funciones básicas como, entre otras, el apetito o el sueño. El objetivo de este estudio es la construcción y validación de un test de cribado para la identificación de estos SNP asociados a patologías neurodegenerativas en etapas preclínicas y prodrómicas y basado en los criterios ISTAART para el Deterioro Conductual Leve (DCoL). Método: Se empleó una muestra de 206 sujetos mayores de 55 años (117 cognitivamente sanos y 89 con Deterioro Cognitivo Leve) siendo el 69% mujeres, con una media de edad de 77 años (DT = 10,58). Resultados: La nueva escala desarrollada consta de 19 items y muestra una estructura unidimensional. La fiabilidad fue excelente (α = .94 y Ω = .97) y se observaron evidencias de validez convergente con el test MBI-C con una correlación de .88 y la NPI-Q con .82. Además, muestra una buena sensibilidad de .88 y especificidad de .80. Conclusiones: La escala desarrollada permite evaluar los SNP en el DCoL mostrando buenas propiedades psicométricas y constituyendo una herramienta muy útil en el diagnóstico precoz de las patologías neurodegenerativas.(AU)

Relationship between episodic memory and volume of the brain regions of two functional cortical memory systems in multiple sclerosis.

BACKGROUND/OBJECTIVE: Two functional networks are proposed as neuronal support for the complex processes of memory: the anterior temporal and the medial posterior systems. We examined the atrophy of hippocampus (HC) and of those areas constituting the two functional memory systems in multiple sclerosis (MS) patients with low disability. METHODS: Episodic memory (EM) was assessed in 88 relapsing MS patients and in 40 healthy controls using Wechsler Memory Scale III (Spanish adaptation). FreeSurfer software was used to calculate normalized volume of total cortex, grey matter, white matter, subcortical grey matter (thalamus and striatum), HC and both the anterior temporal (entorhinal, ventral temporopolar, lateral orbitofrontal, amygdala) and posterior medial systems (thalamus, parahippocampal, posterior cingulate, precuneus, lateral parietal and medial prefrontal). Linear regression analysis was used to identify predictors of memory performance. RESULTS: Total grey matter and cortex volumes correlated with all subtypes of EM, and the precuneus volume correlated with overall, immediate and delayed memories. Univariant regression analysis identified an association between the volumes of the posterior medial memory network regions and EM scores. The volume of the left precuneus area was the unique and independent predictor for all EM subtypes except for visual memory, for which left HC volume was also an independent predictor. CONCLUSION: Left precuneus volume was the best predictor of memory in relapsing MS patients with low disability and mild deficits in EM.

Neuropsychological syndromes in multiple sclerosis / Síndromes neuropsicológicos en la esclerosis múltiple

Background: Cognitive impairment in multiple sclerosis (MS) is common (45-65%).Deficits occur in speed of information processing (SIP), memory, attention, executive functions (EF) and visuoconstruction. Involvement of cognitive functions like language and gnosis is rare and lesser known. Our aim is to describe the cognitive function and the clinical and radiological features of five patients with MS and with neuropsychological syndromes (NPS). Method: Retrospective review of MS patients with NPS studied, using specific tests of SIP, memory, attention, EF, visuo-spatial abilities, praxis and language. Results: The sample included four women (3 relapsing-remitting MS/1 secondary progressive MS) and one man with primary progressive MS (aged between 30-55 years). Cognitive symptoms were the initial complaint in three cases. Three cases presented apperceptive agnosia and constructive apraxia, one case presented alexia with agraphia and the fifth patient presented motor aphasia. Four patients suffered cognitive dysfunction considered typical of MS. Magnetic resonance imaging (MR) in all cases showed high lesion volumes in T1 and T2- weighted sequences. A good correlation was observed between cognitive deficits and the location of the lesions in four patients. Conclusions: NPS may be the initial complaint in MS patients, often associated with other cognitive deficits, and it shows a close relationship with lesion location (AU)

Antecedentes: entre el 45-65% de los pacientes con esclerosis múltiple (EM) manifiestan déficits cognitivos en velocidad de procesamiento de la información (VPI), atención, memoria, funciones ejecutivas (FE) y visuoconstrucción. La alteración del lenguaje y la gnosis visual es infrecuente y poco reconocida. El objetivo es la descripción cognitiva, clínica y radiológica de cinco pacientes con EM con síndromes neuropsicológicos (SNPS). Método: revisión retrospectiva de pacientes de EM con SNPS estudiados mediante test específicos de atención, memoria, VPI, FE, visuoconstrucción, gnosis visual y lenguaje. Resultados: la muestra incluyó cuatro mujeres (3 EM remitente recurrente, 1 EM secundaria progresiva) y un varón con EM primaria progresiva (edades entre 30-55 años). Los déficits cognitivos fueron el síntoma inicial en 3 casos. Tres presentan agnosia aperceptiva y apraxia constructiva, uno alexia con agrafia y el quinto afasia motora. Cuatro asocian disfunción cognitiva ‘típica’ de EM. En resonancia magnética observamos alto volumen lesional en secuencias potenciadas en T1 y T2 y correlación entre los déficits cognitivos y la localización de las lesiones en 4 de ellos. Conclusiones: los SNPS pueden ser la queja inicial en la EM, con frecuencia se asocian a otros déficits cognitivos y manifiestan una estrecha relación con la localización de la lesión (AU)

Neuropsychological syndromes in multiple sclerosis.

BACKGROUND: Cognitive impairment in multiple sclerosis (MS) is common (45-65%).Deficits occur in speed of information processing (SIP), memory, attention, executive functions (EF) and visuoconstruction.Involvement of cognitive functions like language and gnosis is rare and lesser known. Our aim is to describe the cognitive function and the clinical and radiological features of five patients with MS and with neuropsychological syndromes (NPS). METHOD: Retrospective review of MS patients with NPS studied, using specific tests of SIP, memory, attention, EF, visuo-spatial abilities, praxis and language. RESULTS: The sample included four women (3 relapsing-remitting MS/1 secondary progressive MS) and one man with primary progressive MS (aged between 30-55 years). Cognitive symptoms were the initial complaint in three cases. Three cases presented apperceptive agnosia and constructive apraxia, one case presented alexia with agraphia and the fifth patient presented motor aphasia. Four patients suffered cognitive dysfunction considered typical of MS. Magnetic resonance imaging (MR) in all cases showed high lesion volumes in T1 and T2-weighted sequences. A good correlation was observed between cognitive deficits and the location of the lesions in four patients. CONCLUSIONS: NPS may be the initial complaint in MS patients, often associated with other cognitive deficits, and it shows a close relationship with lesion location.