Palabras clave
Dementia
Neuropsychiatric symptoms
Mild behavioral impairment Deterioro conductual leve
Deterioro cognitivo leve
Demencia
Síntomas neuropsiquiátricos
Cómo citar
Resumen
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.
Citas
Aarsland, D., Brønnick, K., Ehrt, U., De Deyn, P. P., Tekin, S., Emre, M., & Cummings, J. L. (2007). Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: Frequency, profile and associated care giver stress. Journal of Neurology, Neurosurgery, and Psychiatry, 78(1), 36–42. https://doi.org/10.1136/jnnp.2005.083113.
Acosta-Castillo, G. I., Luisa Sosa, A., Orozco, R., & Borges, G. (2012). Síntomas neuropsiquiátricos en adultos mayores con demencia y su relación con la severidad de la enfermedad [Neuropsychiatric symptoms in older adults with dementia and their relationship to disease severity]. Revista de Investigacion Clinica, 64(4), 354–363. https://dialnet.unirioja.es/servlet/articulo?codigo=4065278.
Aguera-Ortiz, L. F., Lopez-Alvarez, J., Del Nido-Varo, L., Soria Garcia-Rosel, E., Perez-Martinez, D. A., & Ismail, Z. (2017). Deterioro comportamental leve como antecedente de la demencia: presentacion de los criterios diagnosticos y de la version española de la escala MBI-C para su valoración [Mild behavioural impairment as an antecedent of dementia: presentation of the diagnostic criteria and the Spanish version of the MBI-C scale for its evaluation]. Revista de Neurologia, 65(7), 327–334. https://doi.org/10.33588/rn.6507.2017170
Ballard, C., Day, S., Sharp, S., Wing, G., & Sorensen, S. (2008). Neuropsychiatric symptoms in dementia: importance and treatment considerations. International Review of Psychiatry, 20(4), 396–404. https://doi.org/10.1080/09540260802099968.
Ballard, C., Aarsland, D., Francis, P., & Corbett, A. (2013). Neuropsychiatric symptoms in patients with dementias associated with cortical Lewy bodies: Pathophysiology, clinical features, and pharmacological management. Drugs & Aging, 30(8), 603–611. https://doi.org/10.1007/s40266-013-0092-x.
Banks, S. J., Raman, R., He, F., Salmon, D. P., Ferris, S., Aisen, P., & Cummings, J. (2014). The Alzheimer’s disease cooperative study prevention instrument project: Longitudinal outcome of behavioral measures as predictors of cognitive decline. Dementia and Geriatric Cognitive Disorders Extra, 4(3), 509–516. https://doi.org/10.1159/000357775.
Barua, A., Ghosh, M. K., Kar, N., & Basilio, M. A. (2011). Prevalence of depressive disorders in the elderly. Annals of Saudi Medicine, 31(6), 620– 624. https://doi.org/10.4103/0256-4947.87100.
Blesa, R., Pujol, M., Aguilar, M., Santacruz, P., Bertran-Serra, I., Hernández, G., Sol, J. M., Peña-Casanova, J., & NORMACODEM Group. NORMAlisation of Cognitive and Functional Instruments for DEMentia (2001). Clinical validity of the ‘mini-mental state’ for Spanish speaking communities. Neuropsychologia, 39(11), 1150–1157. https://doi.org/10.1016/s0028-3932(01)00055-0.
Boada, M., Cejudo, J. C., Tàrraga, L., López, O. L., & Kaufer, D. (2002). Neuropsychiatric Inventory Questionnaire (NPI-Q): validación española de una forma abreviada del Neuropsychiatric Inventory (NPI)* [Neuropsychiatric inventory questionnaire (NPI-Q): Spanish validation of an abridged form of the Neuropsychiatric Inventory (NPI)]. Neurologia, 17(6), 317–323. https://pesquisa.bvsalud.org/portal/resource/pt/ibc-16385.
Bryant, C., Jackson, H., & Ames, D. (2008). The prevalence of anxiety in older adults: methodological issues and a review of the literature. Journal of Affective Disorders, 109(3), 233–250. https://doi.org/10.1016/j.jad.2007.11.008.
Burhanullah, M. H., Tschanz, J. T., Peters, M. E., Leoutsakos, J. M., Matyi, J., Lyketsos, C. G., Nowrangi, M. A., & Rosenberg, P. B. (2020). Neuropsychiatric symptoms as risk factors for cognitive decline in clinically normal older adults: The Cache County Study. The American Journal of Geriatric Psychiatry, 28(1), 64–71. https://doi.org/10.1016/j.jagp.2019.03.023.
Calderón Garrido, C., Navarro González, D., Lorenzo Seva, U., & Ferrando Piera, P. J. (2019). Multidimensional or essentially unidimensional? A multi-faceted factor-analytic approach for assessing the dimensionality of tests and items. Psicothema, 31(4), 450–457. https://doi.org/10.7334/psicothema2019.153.
Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, Article 73. https://doi.org/10.3389/fneur.2012.00073.
Chen, T. H., Yeh, Y. C., Huang, M. F., Chen, H. M., Lee, J. I., & Chen, C. S. (2022). Validation and comparison of the informant-rated and selfrated versions of the Mild Behavioral Impairment Checklist. Journal of Alzheimer’s Disease: JAD, 90(3), 1203–1213. https://doi.org/10.3233/JAD-220006.
Cieslak, A., Smith, E. E., Lysack, J., & Ismail, Z. (2018). Case series of mild behavioral impairment: Toward an understanding of the early stages of neurodegenerative diseases affecting behavior and cognition. International Psychogeriatrics, 30(2), 273–280. https://doi.org/10.1017/S1041610217001855.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308–2314. https://doi.org/10.1212/wnl.44.12.2308.
Cummings J. (2021). The role of neuropsychiatric symptoms in research diagnostic criteria for neurodegenerative diseases. The American Journal of Geriatric Psychiatry, 29(4), 375–383. https://doi.org/10.1016/j.jagp.2020.07.011.
Donovan, N. J., Amariglio, R. E., Zoller, A. S., Rudel, R. K., Gomez-Isla, T., Blacker, D., Hyman, B. T., Locascio, J. J., Johnson, K. A., Sperling, R. A., Marshall, G. A., & Rentz, D. M. (2014). Subjective cognitive concerns and neuropsychiatric predictors of progression to the early clinical stages of Alzheimer disease. The American Journal of Geriatric Psychiatry, 22(12), 1642–1651. https://doi.org/10.1016/j.jagp.2014.02.007.
Dubois, B., Slachevsky, A., Litvan, I., & Pillon, B. (2000). The FAB: A Frontal Assessment Battery at bedside. Neurology, 55(11), 1621–1626. https://doi.org/10.1212/wnl.55.11.1621.
Feldman, H., Scheltens, P., Scarpini, E., Hermann, N., Mesenbrink, P., Mancione, L., Tekin, S., Lane, R., & Ferris, S. (2004). Behavioral symptoms in mild cognitive impairment. Neurology, 62(7), 1199–1201. https://doi.org/10.1212/01.wnl.0000118301.92105.ee.
Ferrando, P. J., & Lorenzo-Seva, U. (2017). Program FACTOR at 10: Origins, development and future directions. Psicothema, 29(2), 236–240. https://doi.org/10.7334/psicothema2016.304.
Ferrando, P. J., Lorenzo-Seva, U., Hernández-Dorado, A., & Muñiz, J. (2022). Decalogue for the factor analysis of test items. Psicothema, 34(1), 1-7. https://doi.org/10.7334/psicothema2021.456
Ferrín, M. T., González, L.F., & Meijide-Míguez, H. (2011). Escalas de valoración funcional en el anciano [Functional Assesment Scales in the Elderly]. Galicia Clínica, 72(1), 11-16. https://dialnet.unirioja.es/descarga/articulo/4098178.pdf.
Fischer, C. E., Ismail, Z., & Schweizer, T. A. (2012a). Impact of neuropsychiatric symptoms on caregiver burden in patients with Alzheimer’s disease. Neurodegenerative Disease Management, 2(3), 269–277. https://doi.org/10.2217/nmt.12.19.
Fischer, C. E., Ismail, Z., & Schweizer, T. A. (2012b). Delusions increase functional impairment in Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 33(6), 393–399. https://doi.org/10.1159/000339954.
Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363–389. https://doi.org/10.1146/annurev.clinpsy.032408.153621.
Gómez-Benito, J., Hidalgo, M. D., & Zumbo, B. D. (2013). Effectiveness of combining statistical tests and effect sizes when using logistic discriminant function regression to detect differential item functioning for polytomous items. Educational and Psychological Measurement, 73(5), 875- 897. https://doi.org/10.1177/0013164413492419.
Ismail, Z., Agüera-Ortiz, L., Brodaty, H., Cieslak, A., Cummings, J., Fischer, C. E., Gauthier, S., Geda, Y. E., Herrmann, N., Kanji, J., Lanctôt, K. L., Miller, D. S., Mortby, M. E., Onyike, C. U., Rosenberg, P. B., Smith, E. E., Smith, G. S., Sultzer, D. L., Lyketsos, C., & NPS Professional Interest Area of the International Society of to Advance Alzheimer’s Research and Treatment (NPS-PIA of ISTAART) (2017). The Mild Behavioral Impairment Checklist (MBI-C): A rating scale for neuropsychiatric symptoms in predementia populations. Journal of Alzheimer’s Disease, 56(3), 929–938. https://doi.org/10.3233/JAD-160979.
Ismail, Z., Smith, E. E., Geda, Y., Sultzer, D., Brodaty, H., Smith, G., Agüera-Ortiz, L., Sweet, R., Miller, D., Lyketsos, C. G., & ISTAART Neuropsychiatric Symptoms Professional Interest Area (2016). Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 12(2), 195–202. https://doi.org/10.1016/j.jalz.2015.05.017.
Karttunen, K., Karppi, P., Hiltunen, A., Vanhanen, M., Välimäki, T., Martikainen, J., Valtonen, H., Sivenius, J., Soininen, H., Hartikainen, S., Suhonen, J., Pirttilä, T., & ALSOVA study group (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer’s disease. International Journal of Geriatric Psychiatry, 26(5), 473–482. https://doi.org/10.1002/gps.2550.
Köhler, S., Allardyce, J., Verhey, F. R., McKeith, I. G., Matthews, F., Brayne, C., Savva, G. M., & Medical Research Council Cognitive Function and Ageing Study (2013). Cognitive decline and dementia risk in older adults with psychotic symptoms: a prospective cohort study. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 21(2), 119–128. https://doi.org/10.1016/j.jagp.2012.10.010.
Lanctôt, K. L., Amatniek, J., Ancoli-Israel, S., Arnold, S. E., Ballard, C., Cohen-Mansfield, J., Ismail, Z., Lyketsos, C., Miller, D. S., Musiek, E., Osorio, R. S., Rosenberg, P. B., Satlin, A., Steffens, D., Tariot, P., Bain, L. J., Carrillo, M. C., Hendrix, J. A., Jurgens, H., & Boot, B. (2017). Neuropsychiatric signs and symptoms of Alzheimer’s disease: New treatment paradigms. Alzheimer’s & Dementia, 3(3), 440–449. https://doi.org/10.1016/j.trci.2017.07.001.
Landau, S. M., Harvey, D., Madison, C. M., Reiman, E. M., Foster, N. L., Aisen, P. S., Petersen, R. C., Shaw, L. M., Trojanowski, J. Q., Jack, C. R., Jr, Weiner, M. W., Jagust, W. J., & Alzheimer’s Disease Neuroimaging Initiative (2010). Comparing predictors of conversion and decline in mild cognitive impairment. Neurology, 75(3), 230–238. https://doi.org/10.1212/WNL.0b013e3181e8e8b8.
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Selfmaintaining and instrumental activities of daily living. The Gerontologist, 9(3), 179–186. https://doi.org/10.1093/geront/9.3_1.179.
Leoutsakos, J. M., Forrester, S. N., Lyketsos, C. G., & Smith, G. S. (2015). Latent Classes of Neuropsychiatric Symptoms in NACC controls and conversión to mild cognitive impairment or dementia. Journal of Alzheimer’s Disease, 48(2), 483–493. https://doi.org/10.3233/JAD-150421.
Lobo, A., Saz, P., Marcos, G., Día, J. L., de la Cámara, C., Ventura, T., Morales Asín, F., Fernando Pascual, L., Montañés, J. A., & Aznar, S. (1999). Revalidación y normalización del Mini-Examen Cognoscitivo (primera versión en castellano del Mini-Mental Status Examination) en la población general geriátrica [Revalidation and standardization of the cognition miniexam (first Spanish version of the Mini-Mental Status Examination) in the general geriatric population]. Medicina Clinica, 112(20), 767–774. https://www.elsevier.es/en/linksolver/ft/ivp/0025-7753/112/767.
Lorenzo-Seva, U., & Ferrando, P. J. (2013). FACTOR 9.2: A comprehensive program for fitting exploratory and semiconfirmatory factor analysis and IRT models. Applied Psychological Measurement, 37(6), 497–498. https://doi.org/10.1177/0146621613487794.
Lorenzo-Seva, U., & Ferrando, P. J. (2021). MSA: The forgotten index for identifying inappropriate items before computing exploratory item factor analysis. Methodology, 17(4), 296-306. https://doi.org/10.5964/meth.7185
Mallo, S. C., Ismail, Z., Pereiro, A. X., Facal, D., Lojo-Seoane, C., Campos-Magdaleno, M., & Juncos-Rabadán, O. (2018). Assessing mild behavioral impairment with the Mild Behavioral Impairment-Checklist in people with mild cognitive impairment. Journal of Alzheimer’s Disease, 66(1), 83–95.https://doi.org/10.3233/JAD-180131.
Mallo, S. C., Ismail, Z., Pereiro, A. X., Facal, D., Lojo-Seoane, C., Campos-Magdaleno, M., & Juncos-Rabadán, O. (2019). Assessing mild behavioral impairment with the mild behavioral impairment checklist in people with subjective cognitive decline. International Psychogeriatrics, 31(2), 231–239. https://doi.org/10.1017/S1041610218000698.
Masters, M. C., Morris, J. C., & Roe, C. M. (2015). “Noncognitive” symptoms of early Alzheimer disease: A longitudinal analysis. Neurology, 84(6), 617–622. https://doi.org/10.1212/WNL.0000000000001238.
Meulen, E. F., Schmand, B., van Campen, J. P., de Koning, S. J., Ponds, R. W., Scheltens, P., & Verhey, F. R. (2004). The Seven Minute Screen: A neurocognitive screening test highly sensitive to various types of dementia. Journal of Neurology, Neurosurgery, and Psychiatry, 75(5), 700–705. https://doi.org/10.1136/jnnp.2003.021055.
Nowrangi, M. A., Lyketsos, C. G., & Rosenberg, P. B. (2015). Principles and management of neuropsychiatric symptoms in Alzheimer’s dementia. Alzheimer’s Research & Therapy, 7(1), Article 12. https://doi.org/10.1186/s13195-015-0096-3.
Ortega-Orcos, R., Salinero-Fort, M. A., Khajoui, A. K, Aparicio, S.V, & de Dios del Valle, R. (2007). Validación de la versión española de 5 y 15 ítems de la Escala de Depresión Geriátrica en personas mayores en Atención Primaria [Validation of 5 and 15 items Spanish versión of the geriatric depression scale in elderly subjects in primary health care setting]. Revista Clinica Española, 207(11), 559–562. https://doi.org/10.1157/13111585.
Pink, A., Stokin, G. B., Bartley, M. M., Roberts, R. O., Sochor, O., Machulda, M. M., Krell-Roesch, J., Knopman, D. S., Acosta, J. I., Christianson, T. J., Pankratz, V. S., Mielke, M. M., Petersen, R. C., & Geda, Y. E. (2015). Neuropsychiatric symptoms, APOE ε4, and the risk of incident dementia: a population-based study. Neurology, 84(9), 935–943. https://doi.org/10.1212/WNL.0000000000001307.
Rosenberg, P. B., Mielke, M. M., Appleby, B. S., Oh, E. S., Geda, Y. E., & Lyketsos, C. G. (2013). The association of neuropsychiatric symptoms in MCI with incident dementia and Alzheimer disease. The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry, 21(7), 685–695. https://doi.org/10.1016/j.jagp.2013.01.006.
Sheikh, F., Ismail, Z., Mortby, M. E., Barber, P., Cieslak, A., Fischer, K., Granger, R., Hogan, D. B., Mackie, A., Maxwell, C. J., Menon, B., Mueller, P., Patry, D., Pearson, D., Quickfall, J., Sajobi, T., Tse, E., Wang, M., Smith, E. E., & PROMPT registry investigators (2018). Prevalence of mild behavioral impairment in mild cognitive impairment and subjective cognitive decline, and its association with caregiver burden. International Psychogeriatrics, 30(2), 233–244. https://doi.org/10.1017/S104161021700151X.
Simonetti, A., Pais, C., Jones, M., Cipriani, M. C., Janiri, D., Monti, L., Landi, F., Bernabei, R., Liperoti, R., & Sani, G. (2020). Neuropsychiatric symptoms in elderly with dementia during COVID-19 pandemic: Definition, treatment, and cuture directions. Frontiers in Psychiatry, 11, Article 579842. https://doi.org/10.3389/fpsyt.2020.579842.
Steinberg, M., Shao, H., Zandi, P., Lyketsos, C. G., Welsh-Bohmer, K. A., Norton, M. C., Breitner, J. C., Steffens, D. C., Tschanz, J. T., & Cache County Investigators (2008). Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: The Cache County Study. International Journal of Geriatric Psychiatry, 23(2), 170–177. https://doi.org/10.1002/gps.1858.
Taragano, F. E., Allegri, R. F., Heisecke, S. L., Martelli, M. I., Feldman, M. L., Sánchez, V., García, V. A., Tufro, G., Castro, D. M., Leguizamón, P. P., Guelar, V., Ruotolo, E., Zegarra, C., & Dillon, C. (2018). Risk of conversion to dementia in a mild behavioral impairment group compared to a psychiatric group and to a mild cognitive impairment group. Journal of Alzheimer’s Disease, 62(1), 227–238. https://doi.org/10.3233/JAD-170632.
Teng, E., Lu, P. H., & Cummings, J. L. (2007). Neuropsychiatric symptoms are associated with progression from mild cognitive impairment to Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 24(4), 253–259. https://doi.org/10.1159/000107100.
Wise, E. A., Rosenberg, P. B., Lyketsos, C. G., & Leoutsakos, J. M. (2019). Time course of neuropsychiatric symptoms and cognitive diagnosis in national Alzheimer’s coordinating centers volunteers. Alzheimer’s & Dementia, 11, 333–339. https://doi.org/10.1016/j.dadm.2019.02.006.
Woolley, J. D., Khan, B. K., Murthy, N. K., Miller, B. L., & Rankin, K. P. (2011). The diagnostic challenge of psychiatric symptoms in neurodegenerative disease: Rates of and risk factors for prior psychiatric diagnosis in patients with early neurodegenerative disease. The Journal of Clinical Psychiatry, 72(2), 126–133. https://doi.org/10.4088/JCP.10m06382oli.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37–49. https://doi.org/10.1016/0022-3956(82)90033-4.
Zubenko, G. S., Moossy, J., Martinez, A. J., Rao, G., Claassen, D., Rosen, J., & Kopp, U. (1991). Neuropathologic and neurochemical correlates of psychosis in primary dementia. Archives of Neurology, 48(6), 619–624. https://doi.org/10.1001/archneur.1991.00530180075020.