Escala de reserva cognitiva: ajuste del modelo teórico y baremación / Cognitive Reserve Scale: testing the theoretical model and norms

Introducción. La teoría de la reserva cognitiva contribuiría a explicar las diferencias en el rendimiento intelectual en sujetos con deterioro cognitivo similar y en sujetos sanos. Sin embargo, son necesarios más datos psicométricos que garanticen el uso de los instrumentos de medición de reserva cognitiva. Objetivo. Aportar evidencias de validez respecto a la estructura interna de la escala de reserva cognitiva (ERC) y establecer un baremo de referencia para la interpretación de sus puntuaciones. Sujetos y métodos. Un total de 172 sujetos completaron la ERC y fueron distribuidos en dos grupos en función de la edad: 36-64 años (n = 110) y 65-88 años (n = 62). Resultados. El análisis factorial mediante modelos de ecuaciones estructurales exploratorios indicó un moderado ajuste de los datos al modelo propuesto. En general, los índices de discriminación fueron correctos (entre 0,21 y 0,50), y se registró congruencia entre los ítems a lo largo de los períodos de juventud, adultez y madurez para ambos grupos de edad. Se observaron valores adecuados del índice de fiabilidad (alfa de Cronbach: 0,80) y de los errores típicos de medida (media: 51,40 ± 11,11). Conclusiones. La ERC se enmarcaría dentro del modelo teórico hipotetizado y las puntuaciones podrían interpretarse mediante el baremo ofrecido, lo que avalaría su empleo en la investigación en este campo (AU)

Introduction. The cognitive reserve theory may contribute to explain cognitive performance differences among individuals with similar cognitive decline and among healthy ones. However, more psychometric analysis are needed to guarantee the usage of tests for assessing cognitive reserve. Aims. To study validity evidences in relation to the structure of the Cognitive Reserve Scale (CRS) and to create reference norms to interpret the scores. Subjects and methods. A total of 172 participants completed the scale and they were classified into two age groups: aged 36-64 years (n = 110) and 65-88 years (n = 62). Results. The exploratory factor analysis using ESEM revealed that the data fitted the proposed model. Overall, the discriminative indices were acceptable (between 0.21 and 0.50) and congruence was observed in the periods of young adulthood, adulthood and late adulthood, in both age group. Besides, the index of reliability (Cronbach’s alpha: 0.80) and the typical mean error test (mean: 51.40 ± 11.11) showed adequate values for this type of instrument. Conclusion. The CRS seemed to be set under the hypothetical theoretical model, and the scores might be interpreted by the norms showed. This study provided guarantees for the usage of the CRS in research (AU)

Cognitive Reserve Scale and ageing / Escala de Reserva Cognitiva y envejecimiento

The construct of cognitive reserve attempts to explain why some individuals with brain impairment, and some people during normal ageing, can solve cognitive tasks better than expected. This study aimed to estimate cognitive reserve in a healthy sample of people aged 65 years and over, with special attention to its influence on cognitive performance. For this purpose, it used the Cognitive Reserve Scale (CRS) and a neuropsychological battery that included tests of attention and memory. The results revealed that women obtained higher total CRS raw scores than men. Moreover, the CRS predicted the learning curve, short-term and long-term memory, but not attentional and working memory performance. Thus, the CRS offers a new proxy of cognitive reserve based on cognitively stimulating activities performed by healthy elderly people. Following an active lifestyle throughout life was associated with better intellectual performance and positive effects on relevant aspects of quality of life

El constructo de reserva cognitiva intenta explicar por qué algunos sujetos con patología cerebral o durante el proceso de envejecimiento normal pueden ejecutar tareas cognitivas a un nivel superior al esperado. Los objetivos del presente estudio abarcan la estimación de reserva cognitiva en sujetos sanos a partir de los 65 años y su repercusión a nivel cognitivo. Para ello, se empleó la Escala de Reserva Cognitiva (ERC) y una batería neuropsicológica que englobaba tareas mnésicas y atencionales. Los resultados revelaron que las mujeres obtuvieron mayor puntuación directa en la ERC. Además, la ERC predijo la ejecución en tareas de memoria (curva de aprendizaje y recuerdos a corto plazo y a largo plazo), pero no predijo las puntuaciones en memoria de trabajo ni en atención. Así, la ERC ofreció una estimación de reserva cognitiva, basada en el estilo de vida, en sujetos sanos mayores. Mantener un estilo de vida activo a lo largo de los años favorece la ejecución intelectual y repercute positivamente en facetas relevantes para la calidad de vida

Estimating cognitive reserve in healthy adults using the Cognitive Reserve Scale.

The concept of cognitive reserve emerged from observed disparities between brain pathology and clinical symptoms. It may explain better neuropsychological performance in healthy individuals. The objectives of this study were to measure reserve in healthy subjects using a new Cognitive Reserve Scale (CRS), analyze the internal consistency of the CRS, and analyze validity evidence. A total of 117 healthy individuals were divided into two groups: 87 adults (aged 18-64 years) and 30 elderly adults (≥65 years). All subjects completed the CRS and a comprehensive neuropsychological battery. The internal consistency of the scale was satisfactory (α = 0.77). No significant differences were observed between genders (t = 0.51, p = 0.611), and age was corrected by averaging the CRS score. The study of validity evidence showed that education affected the CRS (t = -2.98, p = 0.004, partial h2 = 0.07) and there was no significant relationship between the CRS and IQ (r = 0.09, p = 0.33). Occupational attainment and the CRS were not related (F2,116 = 0.11, p = 0.898). In line with previous studies on reserve, heterogeneity was observed in the analyses of relationships between the CRS and cognitive performance. There were significant relationships between CRS score and the Verbal Learning Spanish-Complutense Test last trial (r = 0.24, p = 0.009), sum (r = 0.32, p = 0.000), short-term (r = 0.29, p = 0.002) and long-term memory (r = 0.22, p = 0.018), Matrix Reasoning subtest (r = 0.20, p = 0.027) and Block Design subtest (r = 0.20, p = 0.029). No other neuropsychological variables correlated with the CRS (p>0.05). The CRS is a reliable instrument that reflects the frequency of participation in brain-stimulating activities across the lifetime. The associations between the CRS and education and neuropsychological performance support validity evidence.

Cognitive reserve, age, and their relation to attentional and executive functions.

The main objective of this research was to establish the relation between age, cognitive reserve (CR), and attentional and executive functions. One hundred and sixty healthy participants aged 20 to 65 years old completed a wide battery of frontal-lobe tasks using classical tests that assess planning and control of movement, problem solving, and inhibition of automatic response, visuomotor tracking, focused and sustained attention, shifting, spontaneity and reasoning. The total sum of the score in premorbid IQ (by means of the Weschsler Adult Intelligence Scale Vocabulary subtest), educational level, and type of profession was used as a proxy of CR. Subjects were divided into groups of low or high CR. Multiple linear and logistic analyses revealed that age is a predictor of the 20Q Test, Terman Merril's Picture task, Similarities, Digit Span (backward), Trail-Making Tests, Porteus Maze Trace, the "A" Letter Cancellation Test, and reciprocal inhibition. CR is a predictor of the Controlled Oral Word Association Test, Trail-Making Tests A and B, Digit Span (forward), and Similarities. In conclusion, a higher CR score is associated with better performance in almost all tests employed. But it has a significant contribution to performance on verbal fluency, behavioral spontaneity, reasoning, divided and complex attention, and working memory functions, which are mainly related to the dorsolateral prefrontal area.

Construcción de la escala de reserva cognitiva en población española: estudio piloto / Development of the scale of cognitive reserve in Spanish population: a pilot study

Introducción. Durante los últimos años, el interés por la reserva cognitiva ha aumentado notablemente ante la falta de asociación entre el daño cerebral y los síntomas clínicos observados. La complejidad de la reserva cognitiva ha dado lugar a diferentes propuestas para su medición, sin observarse un consenso acerca de cuál es la más acertada. Objetivo. Realizar una aproximación a la medida de la reserva cognitiva en población española a través de la elaboración y el estudio del funcionamiento psicométrico de la escala de reserva cognitiva. Sujetos y métodos. En el estudio piloto participó una muestra de 95 sujetos sanos. La estimación de la fiabilidad de la escala se realizó a través de la consistencia interna. Para el estudio de la validez de contenido se consultó con un grupo de expertos. En relación con la validez de criterio, se estimaron las correlaciones entre las puntuaciones en la escala y los criterios externos de autopercepción y de inteligencia premórbida. Resultados. La estimación de la fiabilidad de la escala se consideró alta (alfa = 0,81) y se registraron unas adecuadas evidencias de validez de contenido. Se observaron correlaciones estadísticamente significativas y de magnitud moderada entre la escala y la inteligencia premórbida (–0,31), y el estado de ánimo (0,25). Conclusiones. La escala de reserva cognitiva podría considerarse un adecuado instrumento experimental como medida de reserva cognitiva en población española. No obstante, sería necesario ampliar el estudio en esta línea (AU)

Introduction. Lately, the interest in cognitive reserve has increased notably in view of the lack of correlation between cerebral damage and observed clinic symptoms. However, there is no consensus on which measure of cognitive reserve is the most accurate. Aim. To develop the scale of cognitive reserve in Spanish population and to study its psychometric properties. Subjects and methods. Ninety-five healthy subjects collaborated in the pilot study. The reliability of the scale was calculated with the internal consistency. A group of experts were consulted for the study of the content validity. In relation to criterion validity, correlations between two measures, autoperception and premorbid intelligence, and the scale were estimated. Results. The analysis revealed a high reliability of the scale (alpha = 0.81) and a suitable content validity. Furthermore, there were statistically significant and mild correlations between the scale and premorbid intelligence (–0.31), and mood state (0.25). Conclusions. The scale of cognitive reserve could be considered as a suitable instrument to measure cognitive reserve in Spanish population. Nevertheless, more research is required (AU)

Déficit mnésicos y perceptivos en la fibromialgia y la artritis reumatoide / Cognition and perception deficits in fibromyalgia and rheumatoid arthritis

Introducción: El deterioro cognitivo en los pacientes con dolor crónico es hoy día un tema de gran interés clínico, debido a que estas personas con frecuencia se quejan de problemas cognitivos. Objetivo: Investigar las capacidades de atención, perceptivas y de memoria visuoespacial en los pacientes con dolor crónico en comparación con un grupo control y evaluar si entre estos pacientes hay diferencias, teniendo en cuenta las características de la propia enfermedad y la capacidad de reserva cognitiva. Material y métodos: Se seleccionó a 2 grupos de pacientes, enfermos de fibromialgia y artritis reumatoide con corta duración de la enfermedad, y se los comparó con un grupo control. Todos los sujetos completaron un protocolo de exploración de memoria visual y espacial, velocidad de procesamiento, memoria de trabajo, visuopercepción, atención y orientación. Para todos ellos se obtuvo una medida de reserva cognitiva. Resultados: Los pacientes con dolor crónico presentan una peor ejecución cognitiva que los controles. Los pacientes con artritis ejecutan la tarea peor que los de fibromialgia cuando requiere mayor velocidad de procesamiento visuomotor y un déficit en la integración en tareas visuoperceptivas. Los enfermos de fibromialgia obtuvieron peores puntuaciones en las tareas de memoria espacial y orientación. Conclusiones: Los pacientes aquejados de fibromialgia y artritis tienen déficit aun cuando la cronicidad de la enfermedad sea breve. Dicho déficit parece no explicarse por efectos colaterales de dichas afecciones, ya que los perfiles cognitivos no son similares y aparecen desde el inicio de la enfermedad (AU)

Introduction: Cognitive disturbance in patients with fibromyalgia and rheumatoid arthritis is today a topic of a great clinical interest, largely due to the fact that these persons often complain about cognitive problems. Objective: This study is aimed to assess the visuospatial memory, attention and perceptive capacities in chronic pain patients. Material and methods: Groups were constituted by fibromyalgia patients and rheumatoid arthritis patients, as well as a control group. All the subjects completed a battery of visual and spatial memory, speed of processing, working memory, attention, orientation and visuoperceptive abilities. A cognitive reserve measurement was obtained. Results: Results show that chronic pain patients displayed worse cognitive performance than controls. Moreover, arthritis patients execute poorly when compared to the group of fibromyalgia in tasks that demand visuoperceptive integration and visuomotor processing. Patients suffering fibromyalgia obtained worse punctuations than those with arthritis in spatial memory and spatial orientation tasks. Conclusions: Both groups developed important cognitive deficits, which cannot be explained by the collateral effects of such pathologies, because cognitive profiles are not similar and appear from the beginning of the disease (AU)

[Cognition and perception deficits in fibromyalgia and rheumatoid arthritis]. / Déficit mnésicos y perceptivos en la fibromialgia y la artritis reumatoide.

INTRODUCTION: Cognitive disturbance in patients with fibromyalgia and rheumatoid arthritis is today a topic of a great clinical interest, largely due to the fact that these persons often complain about cognitive problems. OBJECTIVE: This study is aimed to assess the visuospatial memory, attention and perceptive capacities in chronic pain patients. MATERIAL AND METHODS: Groups were constituted by fibromyalgia patients and rheumatoid arthritis patients, as well as a control group. All the subjects completed a battery of visual and spa-tial memory, speed of processing, working memory, attention, orientation and visuoperceptive abilities. A cognitive reserve measurement was obtained. RESULTS: Results show that chronic pain patients displayed worse cognitive performance than controls. Moreover, arthritis patients execute poorly when compared to the group of fibromyalgia in tasks that demand visuoperceptive integration and visuomotor processing. Patients suffering fibromyalgia obtained worse punctuations than those with arthritis in spatial memory and spatial orientation tasks. CONCLUSIONS: Both groups developed important cognitive deficits, which cannot be explained by the collateral effects of such pathologies, because cognitive profiles are not similar and appear from the beginning of the disease.

Neuropsychological sequelae from acute poisoning and long-term exposure to carbamate and organophosphate pesticides.

UNLABELLED: This research examines the effects of different degrees of pesticide exposure on neuropsychological performance. Exposures varied from acute poisoning coupled with chronic exposure to low or high levels of chronic exposure (defined by years of exposure). A cross-sectional neuropsychological and biochemical study was conducted in greenhouse farmers from southern Spain: data from 24 acutely poisoned workers and 40 non-poisoned but chronically (low or high) exposed sprayers were compared to 26 controls. We examined performance on 21 neuropsychological tests that assessed attention, memory, praxis, gnosis, motor coordination, naming and reasoning and also examined values of plasmatic cholinesterase. Results indicated statistically significant neuropsychological deficits in the acute poisoning and high chronic exposure groups after controlling for confounds, whereas similar performance was seen in the low chronic exposed subjects and controls. Subjects who were acutely poisoned performed worse than the other groups on perceptual, visuomotor, visual memory and mood state domains. Both the acutely poisoned and the chronically high exposed subjects obtained significantly lower scores in the perceptual, verbal memory and visuomotor domains. Levels of butyrylcholinesterase were related to the seasonal sprayer activity except in the case of acutely poisoned subjects. CONCLUSIONS: Both acutely poisoned long-term workers and chronically high (>10 years) exposed workers exhibited similar disturbances in perception and visuo-motor processing, in the absence of any related acute effect of butyrylcholinesterase inhibition. In the case of acutely poisoned subjects, verbal and perceptive learning and recall and constructive abilities were also impaired. These results point to the need for follow-up studies to assess the possible sequelae of chronic and acute exposure to pesticides and their interactions.

Neuropsychological effects of long-term exposure to organophosphate pesticides.

Cholinesterase inhibitors, such as carbamates and organophosphates (OPs), are widely used as insecticides and pesticides and may be stored as biological weapons. The massive use of these products, along with a lack of personal protective equipment on the job, and accidental and intentional ingestions, has produced a great number of poisonings in farmers. A large part of the employment and income in southeastern Spain is concentrated in intensive greenhouse agriculture in which growers are exposed to a varying degree of subsymptomatic doses of a combination of pesticides, mainly OPs and carbamates. We conducted a cross-sectional survey of workers in high-exposure conditions to assess possible neurobehavioral deficits, using a wide array of tasks to test neuropsychological functioning and emotional status. Linear and logistic regression series revealed the importance of the variable "years working with pesticides" as a measure of cumulative exposure for risk of worsened perceptive function performance (odds ratio (OR)=6.93, 95% confidence interval (CI): 1.52-31.51), visuomotor praxis (OR=5.00, 95% CI: 1.22-20.40) and integrative task performance time (OR=4.12, 95% CI: 1.18-14.39) with no relation to plasma cholinesterase activity as a measure of recent exposure. This association was statistically significant after controlling for confounds (age and educational level). The findings showed association of long-term exposure and worse performance in neuropsychological functions, which is interpreted as evidence of a chronic effect of cumulative high exposure to OPs and carbamates.