[A new case of psychotic break as the presenting symptom of anti-NMDA receptor encephalitis. Treatment from a neuropsychiatric approach]. / Nuevo caso de brote psicotico como presentacion de la encefalitis antirreceptor de NMDA. Enfoque de tratamiento desde la neuropsiquiatria.

INTRODUCTION: Limbic encephalitis generated by anti-N-methyl D-aspartate (NMDA) receptor antibodies is a severe acute neurological condition that is more prevalent in young females and is associated with an underlying tumour. The appearance of severe initial psychiatric signs and symptoms and the fact that it is accompanied by emotional disorders and severe cognitive impairment make it necessary to reconsider the contributions of neuropsychiatry to the diagnosis, development and treatment of the disease, since these have received little attention from researchers to date. CASE REPORT: We report on what is, to our knowledge, the only case in Navarra, associated with an ovarian teratoma, with special attention paid to its assessment, intervention and neuropsychiatric development. CONCLUSION: Anti-NMDA receptor encephalitis is a disease that is usually accompanied by predominant psychiatric manifestations at the outset of the illness, together with cognitive deterioration that commonly affects memory and the executive functions. Treatment consisting in beginning a process of rehabilitation that includes compensatory strategies for deficits, cognitive stimulation and psychopharmacological treatment in the recovery phase has proved to be effective.

TITLE: Nuevo caso de brote psicotico como presentacion de la encefalitis antirreceptor de NMDA. Enfoque de tratamiento desde la neuropsiquiatria.Introduccion. La encefalitis limbica generada por anticuerpos antirreceptor de N-metil-D-aspartato (NMDA) es una entidad neurologica aguda y grave, mas prevalente en mujeres jovenes y asociada a un tumor subyacente. La aparicion de sintomatologia psiquiatrica inicial grave y el curso con alteraciones emocionales y deficit cognitivo grave hacen necesario reflexionar sobre las aportaciones, poco estudiadas hasta el momento, de la neuropsiquiatria al diagnostico, la evolucion y el tratamiento de la enfermedad. Caso clinico. Se presenta el unico caso del que se tiene constancia en Navarra, asociado a un teratoma ovarico, atendiendo especialmente a la evaluacion, la intervencion y la evolucion neuropsiquiatrica. Conclusion. La encefalitis antirreceptor de NMDA es una enfermedad que suele cursar con manifestaciones psiquiatricas predominantes en el inicio de la enfermedad, asi como con deterioro cognitivo que afecta habitualmente a la memoria y a las funciones ejecutivas. Se demuestra eficaz iniciar un proceso de rehabilitacion que incluya estrategias compensatorias del deficit, estimulacion cognitiva y tratamiento psicofarmacologico en la fase de recuperacion.

[Comparison of the Wechsler Memory Scale-III and the Spain-Complutense Verbal Learning Test in acquired brain injury: construct validity and ecological validity]. / Comparacion de la escala de memoria de Wechsler-III y el test de aprendizaje verbal España-Complutense en el daño cerebral adquirido: validez de constructo y validez ecologica.

AIMS: To perform an in-depth examination of the construct validity and the ecological validity of the Wechsler Memory Scale-III (WMS-III) and the Spain-Complutense Verbal Learning Test (TAVEC). PATIENTS AND METHODS: The sample consists of 106 adults with acquired brain injury who were treated in the Area of Neuropsychology and Neuropsychiatry of the Complejo Hospitalario de Navarra and displayed memory deficit as the main sequela, measured by means of specific memory tests. The construct validity is determined by examining the tasks required in each test over the basic theoretical models, comparing the performance according to the parameters offered by the tests, contrasting the severity indices of each test and analysing their convergence. The external validity is explored through the correlation between the tests and by using regression models. RESULTS: According to the results obtained, both the WMS-III and the TAVEC have construct validity. The TAVEC is more sensitive and captures not only the deficits in mnemonic consolidation, but also in the executive functions involved in memory. The working memory index of the WMS-III is useful for predicting the return to work at two years after the acquired brain injury, but none of the instruments anticipates the disability and dependence at least six months after the injury. CONCLUSION: We reflect upon the construct validity of the tests and their insufficient capacity to predict functionality when the sequelae become chronic.

TITLE: Comparacion de la escala de memoria de Wechsler-III y el test de aprendizaje verbal España-Complutense en el daño cerebral adquirido: validez de constructo y validez ecologica.Objetivo. Profundizar en la validez de constructo y en la validez ecologica de la escala de memoria de Wechsler-III (WMS-III) y el test de aprendizaje verbal España-Complutense (TAVEC). Pacientes y metodos. La muestra consta de 106 adultos con daño cerebral adquirido atendidos en el Area de Neuropsicologia y Neuropsiquiatria del Complejo Hospitalario de Navarra, con deficit de memoria como secuela principal, medido a traves de test especificos de memoria. Para determinar la validez de constructo se examinan las tareas requeridas en cada prueba sobre los modelos teoricos de base, comparando el rendimiento segun los parametros ofrecidos por los tests, contrastando los indices de gravedad de cada prueba y analizando su convergencia. La validez externa se explora a traves de la correlacion entre las pruebas y mediante modelos de regresion. Resultados. De acuerdo con los resultados obtenidos, la WMS-III y el TAVEC tienen validez de constructo. El TAVEC es mas sensible y capta no solo los deficits en la consolidacion mnesica, sino en las estrategias ejecutivas implicadas en la memoria. El indice de memoria de trabajo de la WMS-III es util para predecir la reincorporacion laboral a los dos años del daño cerebral adquirido, pero ningun instrumento anticipa la discapacidad y la dependencia al menos seis meses despues de la lesion. Conclusion. Se reflexiona sobre la validez de constructo de las pruebas y su capacidad insuficiente para predecir la funcionalidad cuando las secuelas se cronifican.

[Proposed model of executive functions based on factorial analyses]. / Propuesta de un modelo de funciones ejecutivas basado en analisis factoriales.

INTRODUCTION: Since Lezak coined the term executive functions to refer to the mental capabilities that are considered essential for performing efficacious, creative and socially acceptable behaviour, they have gradually grown in importance in neuropsychological research. Different models have been proposed to explain their nature, but there is no general agreement as to whether we are dealing with a unitary construct or a multimodal processing system with independent, but interconnected, components. With the aim of gaining a deeper knowledge of the structure of this construct, researchers have conducted lesion, neuroimaging and, more recently, factorial analysis studies, the latter being seen as a promising methodology for expanding our knowledge about such a generic concept as the executive functions. DEVELOPMENT: The purpose of this study is to carry out a systematic review of factorial models of attention and executive control in adults, between the years 1991 and 2016, using the PubMed, OvidSP and PsycINFO databases. Altogether, 33 papers were reviewed. Based on the literature, an integrating proposal of the executive functions is put forward. CONCLUSIONS: Although we do not have just one single model that can account for the complexity of the executive functions, there does seem to be general agreement on their multidimensionality. In factorial analyses, there is strong evidence of updating, inhibition and alternation, although there are also studies that propose novel factors. Our integrating proposal aims to combine the executive processes found in the literature with their corresponding neuroanatomical correlates, and defends the stance that the ideal methodology should use information from lesion studies, neuroimaging techniques and psychometric-computational models.

TITLE: Propuesta de un modelo de funciones ejecutivas basado en analisis factoriales.Introduccion. Desde que Lezak acuñara el termino de funciones ejecutivas como las capacidades mentales esenciales para llevar a cabo una conducta eficaz, creativa y aceptada socialmente, estas han adquirido progresivo protagonismo en la investigacion neuropsicologica. Diversos modelos han sido planteados para explicar su naturaleza, pero no existe consenso respecto a si nos encontramos ante un constructo unitario o un sistema de procesamiento multimodal con componentes independientes, pero interconectados. Para conocer la estructura de este constructo se han utilizado estudios de lesion, neuroimagen y, recientemente, el analisis factorial, que se plantea como una metodologia prometedora para ampliar nuestro conocimiento sobre un concepto tan generico como las funciones ejecutivas. Desarrollo. El proposito de este estudio es realizar una revision sistematica de modelos factoriales de atencion y control ejecutivo en adultos, entre los años 1991-2016, utilizando las bases de datos PubMed, OvidSP y PsycINFO. En total, se revisaron 33 articulos. A partir de la bibliografia, se realiza una propuesta integradora de los procesos ejecutivos. Conclusiones. Aunque no disponemos de un unico modelo que pueda explicar la complejidad de las funciones ejecutivas, si parece existir acuerdo respecto a su multidimensionalidad. En analisis factoriales, actualizacion, inhibicion y alternancia gozan de fuerte evidencia, si bien hay trabajos que plantean factores novedosos. Nuestra propuesta integradora trata de combinar los procesos ejecutivos hallados en la bibliografia con sus correspondientes correlatos neuroanatomicos, defendiendo que la metodologia ideal deberia utilizar informacion procedente de estudios de lesion, tecnicas de neuroimagen y modelos psicometricos-computacionales.

[Impact of acquired brain injury towards the community integration: employment outcome, disability and dependence two years after injury]. / Impacto del daño cerebral adquirido en la integracion comunitaria: reinsercion laboral, discapacidad y dependencia dos años despues de la lesion.

AIMS: To analyze the impact of acquired brain injury towards the community integration (professional career, disability, and dependence) in a sample of people affected by vascular, traumatic and tumor etiology acquired brain damage, over a two year time period after the original injury, and also to examine what sociodemographic variables, premorbid and injury related clinical data can predict the level of the person's integration into the community. PATIENTS AND METHODS: 106 adults sample suffering from acquired brain injury who were attended by the Neuropsychology and Neuropsychiatry Department at Hospital of Navarra (Spain) affected by memory deficit as their main sequel. Differences among groups have been analyzed by using t by Student, chi squared and U by Mann-Whitney tests. RESULTS: 19% and 29% of the participants who were actively working before the injury got back their previous status within one and two years time respectively. 45% of the total sample were recognized disabled and 17% dependant. No relationship between sociodemographic and clinical variables and functional parameters observed were found. CONCLUSIONS: Acquired brain damage presents a high intensity impact on affected person's life trajectory. Nevertheless, in Spain, its consequences at sociolaboral adjustment over the the two years following the damage through functional parameters analyzed with official governmental means over a vascular, traumatic and tumor etiology sample had never been studied before.

TITLE: Impacto del daño cerebral adquirido en la integracion comunitaria: reinsercion laboral, discapacidad y dependencia dos años despues de la lesion.Objetivos. Analizar el impacto del daño cerebral adquirido en la integracion comunitaria (trayectoria laboral, discapacidad y dependencia) en una muestra de sujetos con daño cerebral adquirido de etiologia vascular, traumatica y tumoral, durante un periodo de dos años tras la lesion original, y examinar que variables sociodemograficas, datos clinicos premorbidos y relacionados con la lesion predicen la integracion en la comunidad. Pacientes y metodos. Muestra de 106 sujetos adultos con daño cerebral adquirido, atendidos en el Area de Neuropsicologia y Neuropsiquiatria del Complejo Hospitalario de Navarra, con deficit de memoria como secuela principal. Las diferencias entre grupos se analizan con los tests t de Student, chi al cuadrado y U de Mann-Whitney. Resultados. De los participantes que antes de la lesion se encontraban activos laboralmente, el 19% y 29% recuperaron su estatus previo al año y a los dos años, respectivamente; a un 45% de la muestra total se le reconocio la discapacidad, y a un 17%, la dependencia. No se hallo relacion entre las variables sociodemograficas y clinicas y los parametros funcionales contemplados. Conclusiones. La lesion cerebral adquirida impacta con intensidad en la trayectoria vital de los afectados, aunque no se han estudiado antes en España sus consecuencias en el ajuste sociolaboral en los dos años siguientes al daño a traves de parametros funcionales valorados con instrumentos oficiales estatales en una muestra de etiologia vascular, traumatica y tumoral.

[Contributions of neuropsychology to anti-NMDA receptor antibody encephalitis: a literature review]. / Aportaciones de la neuropsicologia a la encefalitis por anticuerpos antirreceptor de NMDA: revision de la bibliografia.

Limbic encephalitis generated by anti-N-methyl-D-aspartate (NMDA) receptor antibodies is an acute and severe neurological entity, which is more prevalent in young females and is associated to an underlying tumour. Since it leads to severe cognitive impairment, thought needs to be given to the contributions of neuropsychology to the diagnosis, development and treatment of the disease, which have received little attention from researchers to date. A review is conducted of the prior literature, evaluating the measurement of the cognitive symptoms (predominantly mnemonic and executive) associated to this disease. Valid, reliable neuropsychological instruments are proposed, and it is suggested that neuropsychological measures may be used as parameters to follow up these patients which help monitor their functionality in daily living once they have recovered from the acute phase. Similarly they can become a basis on which to assemble rehabilitation programmes that favour the accomplishment of personal autonomy and the patients' reintegration in the community. Nevertheless, we stress the need to include neuropsychologists and neuropsychiatrists in not only the detection but also the treatment of these patients so as to enable them to recover their personal independence and re-adapt to their natural settings.

TITLE: Aportaciones de la neuropsicologia a la encefalitis por anticuerpos antirreceptor de NMDA: revision de la bibliografia.La encefalitis limbica generada por anticuerpos antirreceptor de N-metil-D-aspartato (NMDA) es una entidad neurologica aguda y grave, mas prevalente en las mujeres jovenes y asociada a un tumor subyacente. El curso con deficit cognitivo grave hace necesario reflexionar sobre las aportaciones de la neuropsicologia al diagnostico, evolucion y tratamiento de la enfermedad, poco estudiadas hasta el momento. Se revisa la bibliografia precedente, criticando la medicion de los sintomas cognitivos (predominantemente mnesicos y ejecutivos) asociados a esta enfermedad. Se proponen instrumentos neuropsicologicos validos y fiables, y se plantea que las medidas neuropsicologicas pueden servir como parametros de seguimiento de estos pacientes que ayuden a monitorizar su funcionalidad en la vida diaria una vez recuperados de la fase aguda, asi como convertirse en una base sobre la que articular programas de rehabilitacion que favorezcan el logro de la autonomia personal y la reinsercion comunitaria de los pacientes. Con todo, se subraya la necesidad de incluir a neuropsicologos y neuropsiquiatras no solo en la deteccion, sino en el tratamiento de los pacientes, en pro de alcanzar la recuperacion de la independencia personal y la readaptacion a sus entornos naturales.

Estructura factorial del cuestionario disejecutivo en una muestra de población española con daño cerebral adquirido y quejas de déficit de memoria / Factorial structure of the dysexecutive questionnaire in a sample of the Spanish population with acquired brain injury and memory deficit complaints

Introducción y objetivo. El cuestionario disejecutivo (DEX) se ha utilizado para estudiar los déficits ejecutivos en muestras clínicas (psiquiátricas y neurológicas) y no clínicas, aunque no existe un acuerdo sobre su estructura factorial. El objetivo del presente trabajo es estudiar dicha estructura en la versión autoadministrada en una muestra de población española con daño cerebral adquirido y quejas de pérdida de memoria, y comparar dicha solución con las obtenidas en otros estudios. Pacientes y métodos. Se administró el cuestionario a 119 sujetos con daño cerebral adquirido de diferente etiología (traumática, vascular, tumoral, esclerosis múltiple, tóxico-metabólica y otras). Resultados. El coeficiente alfa de Cronbach fue de 0,88. Todos los ítems muestran una adecuada capacidad discriminativa salvo el ítem 15. No se encuentra relación entre la puntuación total en el DEX y la edad, el sexo y el tiempo transcurrido desde la lesión. Se confirma una correlación negativa entre la puntuación total y el nivel de estudios alcanzado. La puntuación total no sigue una distribución normal. La solución de cinco factores explica mayor porcentaje de la varianza total que las de dos, tres y cuatro factores (63,76%). Conclusiones. La versión española del DEX es un instrumento válido para evaluar síntomas disejecutivos generales en sujetos con daño cerebral adquirido. La estructura factorial de cinco factores (planificación, control cognitivo, inhibición, conciencia social y control de impulsos) aporta una mayor riqueza al medir más aspectos de la patología disejecutiva, y por ello parece más útil en el ámbito clínico. Se aconseja la utilización del cuestionario en una fase de evaluación inicial o de cribado y de forma complementaria a la versión heteroinformada (AU)

Introduction and aims. The dysexecutive questionnaire (DEX) has been used to study executive deficits in both clinical samples (both psychiatric and neurological) and non-clinical samples, although agreement on its factorial structure is lacking. The aim of this research is to study that structure in the self-administered version in a sample of the Spanish population with acquired brain injury and memory loss complaints, and to compare that solution with those obtained in other studies. Patients and methods. The questionnaire was administered to 119 subjects with acquired brain injury with different aetiologies (traumatic, vascular, tumours, multiple sclerosis, toxic-metabolic and others). Results. The Cronbach’s alpha coefficient was 0.88. All the items showed adequate discriminatory power, except item 15. No relation was found between the total score on the DEX and the age, gender and time elapsed since the injury. A negative correlation between total score and level of schooling was confirmed. The total score does not follow a normal distribution. The five-factor solution accounts for a higher percentage of the total variance than those of two, three and four factors (63.76%). Conclusions. The Spanish version of the DEX is an instrument that is valid for evaluating general dysexecutive symptoms in subjects with acquired brain injury. The five-factor factorial structure (planning, cognitive control, inhibition, social awareness and impulse control) offers a greater wealth of information because it measures more aspects of the dysexecutive pathology and therefore appears to be more useful in the clinical setting. It is advisable to use the questionnaire in an early stage of evaluation or screening and to use it as a complement to the proxy-reported version (AU)

[Cerebellar contribution to cognitive process: current advances]. / Contribucion del cerebelo a los procesos cognitivos: avances actuales.

INTRODUCTION: The cerebellum has traditionally been considered a neuronal system which is an essential part of coordination and motor control. However, in recent decades the idea of the cerebellum as an organ related to high level cognitive processes has gained strength, a claim supported by studies carried out on animals and humans with cerebellar lesions such as the contribution of modern neuroimaging techniques. DEVELOPMENT: The contribution of the cerebellum is reviewed in different cognitive functions such as the regulation of motor functions, attention, language, visuoconstructional skills, learning, memory and executive functions. The results of said review produce, as the most clarifying data, the influence of the cerebellum on processes such as attention, working memory (covert articulation) and verbal fluency as well as procedural learning. The results found regarding the cerebellum and the executive functions are not conclusive. CONCLUSIONS: We consider it necessary to systematize the table that has already been outlined. This will enable us to answer not only the question of whether the cerebellum plays a role in human cognition but which is its role. Perhaps the basis for understanding the cognitive functions of the cerebellum are not found in the fact that the cerebellum contains functions but that it relates the intention to the action in the emotional as well as the behavioural cognitive plane although the role of 'interface' is found closer to the output processes than processing of functions with a motor component.

[The role of the cerebellum in the regulation of affection, emotion and behaviour]. / Participacion del cerebelo en la regulacion del afecto, la emocion y la conducta.

INTRODUCTION: In recent decades there has been a significant increase in the number of articles that have drawn attention to the possible importance of the role of the cerebellum in non-motor functions. Schmahmann and Sherman, for example, have described the cognitive, behavioural and emotional pattern of what has been called cerebellar cognitive affective syndrome. A central aspect of this disorder is the dysregulation of affect that occurs when lesions involve what has been called the limbic cerebellum (mainly the vermis). DEVELOPMENT: A non-systematic review of the most important literature on the role of the cerebellum in emotional and behavioural regulation was carried out. Two lines of analysis were followed. The first of them was the study of the psycho-pathological symptoms or neuropsychiatric disorders presented by patients suffering from different cerebellar pathologies ranging from congenital pathologies such as agenesis of the cerebellum, dysplasia or hypoplasia to other acquired diseases like tumours in the posterior fossa, cerebellitis or superficial siderosis. In such cases it has been seen that when the cerebellar vermis is compromised, patients display disorders affecting their behaviour and emotions, and psychiatric pathologies are more frequent. In the second line, we analysed the role played by the cerebellum in different psycho-pathological disorders in which the structure of the cerebellum was found to be altered. Although not universal, these alterations were consistent, since they involve the cerebellar vermis. CONCLUSIONS: Although the body of evidence continues to grow, a critical review of the scientific literature leads us to reflect on evolution in the study of the cerebral substrate underlying the cognitive functions and the evolution undergone by this study.

¿Son lo mismo inteligencia y funciones ejecutivas? / Are intelligence and executive functions the same thing?

Introducción. Con el auge de la ciencia cognitiva, el estudio de los componentes cognitivos que intervienen en la resolución de las pruebas que valoran la inteligencia adquiere especial relevancia. Desde esta perspectiva, el factor g se concibe como el representante de la operación de procesos cognitivos de alto nivel que controlan los programas computacionales del cerebro. Se han utilizado diferentes nombres para designar a los procesos cognitivos que subyacen al factor g: procesos de control, funcionamiento ejecutivo, control ejecutivo o funciones ejecutivas. Desarrollo. Se revisa la relación de la inteligencia con la memoria de trabajo y con el constructo de las funciones ejecutivas. Asimismo, se revisa la relación entre la inteligencia y el córtex prefrontal como posible sustrato neuroanatómico de ésta. Conclusiones. Los estudios revisados ofrecen diferentes respuestas a la cuestión de si son lo mismo inteligencia y funciones ejecutivas, siendo la hipótesis que goza de mayor aceptación la que considera que inteligencia y funciones ejecutivas se superponen en algunos aspectos, pero en otros no (AU)

Introduction. With the growth of cognitive science, the study of the cognitive components involved in solving tests to assess intelligence become especially significant. From this perspective, the g factor is conceived as the representative ofthe operation of high-level cognitive processes that control the computational programmes of the brain. Different names have been used to denominate the cognitive processes that underlie the g factor: control processes, executive functioning, executive control or executive functions. Development. We review the relationship between intelligence, on the one hand, and working memory and the executive functions construct, on the other. Furthermore, the article also reviews the relationship between intelligence and the prefrontal cortex, as its possible neuroanatomical substrate. Conclusions. The studies that were surveyed offer different answers to the question of whether intelligence and the executive functions are one and the same thing, the most widely accepted hypothesis being the one that sees intelligence and the executive functions as overlapping in some aspects but not in others (AU)

Evaluación de la memoria en el daño cerebral adquirido: comparación entre la escala de memoria de Wechsler y el test conductual de memoria de Rivermead / Evaluation of memory in acquired brain injury: a comparison between the wechsler memory scale and the rivermead behaviour memory test

Introducción. La afectación de los procesos de aprendizaje y memoria en el daño cerebral adquirido (DCA) es muy frecuente, a la par que heterogénea, generadora de déficit en otras capacidades cognitivas y de limitaciones funcionales significativas. Una buena evaluación neuropsicológica de la memoria pretende estudiar no sólo el tipo, intensidad y naturaleza de los problemas, sino su manifestación en la vida diaria. Pacientes y métodos. Este estudio examina la correlación entre un test de memoria tradicional, la escala de memoria de Wechsler-III (WMS-III), y un test de memoria considerado funcional, el test conductual de memoria de Rivermead (RBMT), en una muestra de 60 pacientes con DCA. Resultados. Todas las correlaciones obtenidas fueron moderadas. Entre los subtest de memoria verbal se encontraron mayores correlaciones que entre los de memoria visual. Un número importante de sujetos con puntuaciones escalares por debajo de la normalidad en la WMS-III realizaron correctamente (de forma total o parcial) la prueba correspondiente en el RBMT. Conclusiones. El uso combinado en la evaluación de la WMS-III y RBMT puede aportar un análisis más comprensivo de los déficit de memoria y su rehabilitación. La ejecución inferior en la WMS-III que en el RBMT indica una mayor sensibilidad del primero, aunque son necesarios estudios futuros que comparen los rendimientos en los test con las limitaciones funcionales valoradas subjetivamente por el paciente y su entorno, para determinar cuál de ambas pruebas posee un mejor equilibrio entre sensibilidad y especificidad, y un mayor valor predictivo (AU)

Introduction. Learning processes and memory are frequently compromised in acquired brain injury (ABI), while at the same time such involvement is often heterogeneous and a source of deficits in other cognitive capacities and significant functional limitations. A good neuropsychological evaluation of memory is designed to study not only the type, intensity and nature of the problems, but also the way they manifest in daily life. Patients and methods. This study examines the correlation between a traditional memory test, the Wechsler Memory Scale-III (WMS-III), and a memory test that is considered to be functional, the Rivermead Behavioural Memory Test (RBMT), in a sample of 60 patients with ABI. Results. All the correlations that were observed were moderate. Greater correlations were found among the verbal memory subtests than among the visual memory tests. An important number of subjects with below-normal scalar scores on the WMS-III correctly performed (either fully or partially) the corresponding test in the RBMT. Conclusions. The joint use of the WMS-III and RBMT in evaluation can provide a more comprehensive analysis of the memory deficits and their rehabilitation. The lower scores obtained in the WMSIII compared to those of the RBMT indicate greater sensitivity of the former. Nevertheless, further testing needs to be carried out in the future to compare the performance in the tests after the patients and those around them have subjectively assessed their functional limitations. This would make it possible to determine which of the two tests offers the best balance between sensitivity and specificity, as well as a higher predictive value (AU)

[Evaluation of memory in acquired brain injury: a comparison between the Wechsler Memory Scale and the Rivermead Behaviour Memory Test]. / Evaluación de la memoria en el daño cerebral adquirido: comparación entre la escala de memoria de Wechsler y el test conductual de memoria de Rivermead.

INTRODUCTION: Learning processes and memory are frequently compromised in acquired brain injury (ABI), while at the same time such involvement is often heterogeneous and a source of deficits in other cognitive capacities and significant functional limitations. A good neuropsychological evaluation of memory is designed to study not only the type, intensity and nature of the problems, but also the way they manifest in daily life. PATIENTS AND METHODS: This study examines the correlation between a traditional memory test, the Wechsler Memory Scale-III (WMS-III), and a memory test that is considered to be functional, the Rivermead Behavioural Memory Test (RBMT), in a sample of 60 patients with ABI. RESULTS: All the correlations that were observed were moderate. Greater correlations were found among the verbal memory subtests than among the visual memory tests. An important number of subjects with below-normal scalar scores on the WMS-III correctly performed (either fully or partially) the corresponding test in the RBMT. CONCLUSIONS: The joint use of the WMS-III and RBMT in evaluation can provide a more comprehensive analysis of the memory deficits and their rehabilitation. The lower scores obtained in the WMS-III compared to those of the RBMT indicate greater sensitivity of the former. Nevertheless, further testing needs to be carried out in the future to compare the performance in the tests after the patients and those around them have subjectively assessed their functional limitations. This would make it possible to determine which of the two tests offers the best balance between sensitivity and specificity, as well as a higher predictive value.

[Alien hand syndrome: a review of the literature]. / Sindrome de la mano ajena: revision de la bibliografia.

INTRODUCTION: Alien hand syndrome (AHS) is a rare neurological disorder, but is an important condition because of its disabling impact on the daily life. The common feature of AHS is the involuntary, autonomous motor activity of the affected limb and the denial of limb ownership, characterized by involuntary, uncontrollable, and purposeless movements. DEVELOPMENT: AHS as a nosologic entity has been modified during the last decades, being able to be a result of several diseases involving corpus callosum or medial frontal cortex, although some authors reported cases of AHS in patients due to posterior cerebral lesions. Frontal AHS occurs in the dominant hand, is associated with grasping, groping and compulsive manipulation of tools. Callosal subtype is characterized by inter-manual conflict and was the first to been described en the context of callosal disconnection. CONCLUSIONS: Alien hand behaviours are increased in conditions of fatigue or anxiety and are usually elicited by nearby objects. The rehabilitative treatment, targeted toward the specific needs of each patient, could allow the improvement of the activities of daily life.

Síndrome de la mano ajena: revisión de la bibliografía / Alien hand syndrome: A review of the literature

Introducción. El síndrome de la mano ajena (SMA) es un trastorno neurológico poco frecuente, pero importante, debido al impacto por incapacitación que produce en la vida diaria. El rasgo común al SMA es la actividad motora autónoma e involuntaria del miembro afecto; y la sensación de extrañeza sentida por el paciente, caracterizado por movimientos involuntarios, incontrolables y sin objetivo. Desarrollo. El síndrome como entidad nosológica se ha modificado durante las últimas décadas, y puede ser resultado de enfermedades que involucren al cuerpo calloso o al córtex frontomedial, aunque algunos autores han descrito casos de SMA en pacientes debido a lesiones posteriores. La forma frontal de SMA aparece en la mano dominante, se asocia a grasping, groping y manipulación compulsiva de instrumentos. El subtipo calloso se caracteriza por el conflicto intermanual, y es el primero en ser descrito en el contexto de casos de desconexión callosa. Conclusiones. Los comportamientos de mano ajena se incrementan en condiciones de fatiga o ansiedad y se desencadenan normalmente por objetos cercanos. El tratamiento rehabilitador, dirigido hacia las necesidades específicas de cada paciente, podría permitir la mejoría en la consecución de las actividades de la vida diaria (AU)

Introduction. Alien hand syndrome (AHS) is a rare neurological disorder, but is an important condition because of its disabling impact on the daily life. The common feature of AHS is the involuntary, autonomous motor activity of the affected limb and the denial of limb ownership, characterized by involuntary, uncontrollable, and purposeless movements. Development. AHS as a nosologic entity has been has been modified during the last decades, being able to be a result of several diseases involving corpus callosum or medial frontal cortex, although some authors reported cases of AHS in patients due to posterior cerebral lesions. Frontal AHS occurs in the dominant hand, is associated with grasping, groping and compulsive manipulation of tools. Callosal subtype is characterized by inter-manual conflict and was the first to been described en the context of callosal disconnection. Conclusions. Alien hand behaviours are increased in conditions of fatigue or anxiety and are usually elicited by nearby objects. The rehabilitative treatment, targeted toward the specific needs of each patient, could allow the improvement of the activities of daily life (AU)

[Models of executive control and functions. II]. / Modelos de funciones y control ejecutivo. II.

INTRODUCTION: Current models of the executive functions enable us to state that this construct embraces a large number of processes and sub processes that are in turn linked to different regions of the brain, and more specifically to the prefrontal cortex. Recent data suggest that different areas of the prefrontal cortex may be involved in a number of aspects related to executive functioning. DEVELOPMENT: The aim of this article is to review the most important models of executive functioning in order to shed light on this controversial construct. The models put forward to date approach the same reality from a number of different perspectives, although in some cases they neglect certain parts of that reality. In this second part of our paper, we review the dynamic filter theory, the differential axes model, the theory of cognitive complexity and control, the theory of hierarchical representation, the attentional control model, the supervisory attentional system and the input hypothesis. CONCLUSIONS: From the results obtained in the studies that were reviewed we can state that it is possible to divide the 'executive functions' construct into sub processes in order to make understanding, assessment and intervention easier. Each of these sub processes seems to be related to a specific area in the prefrontal cortex, although a particular region can be involved in different aspects of executive functioning at different moments in time.

Modelos de funciones y control ejecutivo (II) / Models of executive control and functions

Introducción. Los modelos actuales de funciones ejecutivas nos permiten afirmar que este constructo aglutina una gran cantidad de procesos y subprocesos ligados a su vez a distintas regiones cerebrales en general y a la corteza prefrontal en particular. Datos recientes apuntan a que diferentes regiones de la corteza prefrontal pueden mediar en distintos aspectos implicados en el funcionamiento ejecutivo. Desarrollo. El propósito de este artículo es realizar una revisión de los principales modelos de funcionamiento ejecutivo con el fin de arrojar luz sobre este controvertido constructo. Los modelos planteados realizan aproximaciones a una misma realidad desde perspectivas diferentes, obviando, en algunos casos, partes de esta realidad. En esta segunda parte se revisan la teoría del filtro dinámico, el modelo de los ejes diferenciales en el control ejecutivo, la teoría de la complejidad cognitiva y control, la hipótesis de la representación jerárquica, el modelo de control atencional, el sistema atencional supervisor y la hipótesis de la entrada. Conclusiones. Los resultados obtenidos en los estudios revisados nos permiten afirmar que el constructo ‘funciones ejecutivas’ puede dividirse en subprocesos para su mejor comprensión, evaluación e intervención. Cada uno de estos subprocesos parece estar relacionado con regiones específicas de la corteza prefrontal, si bien una misma región puede estar implicada en distintos aspectos del funcionamiento ejecutivo en diferentes momentos temporales (AU)

Introduction. Current models of the executive functions enable us to state that this construct embraces a large number of processes and sub processes that are in turn linked to different regions of the brain, and more specifically to the prefrontal cortex. Recent data suggest that different areas of the prefrontal cortex may be involved in a number of aspects related to executive functioning. Development. The aim of this article is to review the most important models of executive functioning in order to shed light on this controversial construct. The models put forward to date approach the same reality from a number of different perspectives, although in some cases they neglect certain parts of that reality. In this second part of our paper, we review the dynamic filter theory, the differential axes model, the theory of cognitive complexity and control, the theory of hierarchical representation, the attentional control model, the supervisory attentional system and the input hypothesis. Conclusions. From the results obtained in the studies that were reviewed we can state that it is possible to divide the ‘executive functions’ construct into sub processes in order to make understanding, assessment and intervention easier. Each of these sub processes seems to be related to a specific area in the prefrontal cortex, although a particular region can be involved in different aspects of executive functioning at different moments in time (AU)

Modelos de funciones y control ejecutivo (I) / Models of executive control and functions (I)

Los seres humanos somos capaces de hacer frente a situaciones novedosas y de adaptarnos a loscambios de forma flexible. Las habilidades cognitivas que permiten al individuo controlar y regular sus comportamientos reciben el nombre de funciones ejecutivas. Anatómicamente, las funciones ejecutivas dependen de un sistema neuronal distribuido,en el cual el córtex prefrontal desempeña un papel destacado. Datos recientes apuntan a que diferentes regiones del córtex prefrontal pueden mediar en distintos aspectos implicados en el funcionamiento ejecutivo. Desarrollo. El propósito deeste artículo es realizar una revisión de los principales modelos de funcionamiento ejecutivo con el fin de arrojar luz sobre este controvertido constructo. Los modelos planteados realizan aproximaciones a una misma realidad desde perspectivas diferentes, obviando, en algunos casos, partes de esta realidad. En esta primera parte, se revisan los modelos y teorías de la información contextual, del acontecimiento complejo estructurado, de memoria de trabajo, de codificación adaptativa, la teoría integradora de Miller y Cohen, y los modelos factoriales de control ejecutivo. Conclusiones. No disponemos de un modeloúnico que nos permita explicar cómo procesos cognitivos específicos se controlan y coordinan durante la ejecución de actividades cognitivas complejas. No obstante, existe cierto consenso en aceptar que el constructo funciones ejecutivas noconstituye un concepto unitario, sino la combinación de diversos procesos cognitivos que se combinan de múltiples maneras para operar en diferentes situaciones

As human beings we are capable of coping with novel situations and adapting to changes in a flexiblemanner. The cognitive skills that allow individuals to control and regulate their behaviour are called executive functions. Anatomically, the executive functions depend on a distributed neural system, in which the prefrontal cortex plays an essentialrole. Recent data suggest that different regions of the prefrontal cortex may be involved in a number of aspects of executive functioning. Development. The purpose of this article is to carry out a review of the main models of executive functioning in order to shed light on this controversial construct. The models put forward to date approach the same reality from a number of different perspectives, in some case avoiding certain parts of that reality. In this first part, we review the models and theories of contextual information, structured complex events, working memory, adaptive encoding, Miller and Cohen’s integrating theory, and the factorial models of executive control. Conclusions. There is no single model that allows us to explain how specific cognitive processes are controlled and coordinated while complex cognitive activities are beingperformed. Nevertheless, some agreement has been reached on accepting the idea that the executive functions construct does not consist of a single concept, but instead a combination of several cognitive processes that combine in a number of ways in order to operate in different situations

[Models of executive control and functions (I)]. / Modelos de funciones y control ejecutivo (I).

INTRODUCTION: As human beings we are capable of coping with novel situations and adapting to changes in a flexible manner. The cognitive skills that allow individuals to control and regulate their behaviour are called executive functions. Anatomically, the executive functions depend on a distributed neural system, in which the prefrontal cortex plays an essential role. Recent data suggest that different regions of the prefrontal cortex may be involved in a number of aspects of executive functioning. DEVELOPMENT: The purpose of this article is to carry out a review of the main models of executive functioning in order to shed light on this controversial construct. The models put forward to date approach the same reality from a number of different perspectives, in some case avoiding certain parts of that reality. In this first part, we review the models and theories of contextual information, structured complex events, working memory, adaptive encoding, Miller and Cohen's integrating theory, and the factorial models of executive control. CONCLUSIONS: There is no single model that allows us to explain how specific cognitive processes are controlled and coordinated while complex cognitive activities are being performed. Nevertheless, some agreement has been reached on accepting the idea that the executive functions construct does not consist of a single concept, but instead a combination of several cognitive processes that combine in a number of ways in order to operate in different situations.