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INECO Frontal Screening: an Instrument to assess Executive Dysfunction in Schizophrenia

  • Tânia Silva (a1), Luís Monteiro (a1) and Emanuela Lopes (a2)

Although several brief sensitive screening tools are available to detect executive dysfunction, few have been developed to quickly assess executive functioning. The INECO Frontal Screening (IFS) is a brief tool which has proved be useful for the assessment of the executive functions in patients with dementia. The aim of this study was to explore whether the IFS is as sensitive and specific as the BADS, a battery designed to assess the dysexecutive syndrome, in schizophrenia. Our sample comprised a group of 34 schizophrenic patients (Mean age = 39.59, DP = 10.697) and 31 healthy controls (Mean age = 35.52, DP = 10.211). To all groups were administered the BADS, Wisconsin Card Sorting Test and IFS. The results suggest that schizophrenic patients performed significantly worse than the control group in all tests (p < .05). The IFS total score was 13.29 for the experimental group and 26.21 for the control group (p < .001). Considering a cut-off of 14 points, the IFS sensitivity was 100% and specificity 56% in detection of executive dysfunction in schizophrenia, compared with the BADS, that if we consider a cut-off of 11 points, was a sensitivity of 100% and a specificity of 50%. Thus, IFS is a brief, sensitive and specific tool for the detection of executive dysfunction in schizophrenia.

Corresponding author
*Correspondence concerning this article should be addressed to Tânia S. Silva. Instituto Superior de Ciências da Saúde - Norte. Rua Central de Gandra, 1317. 4585–116. Gandra (Portugal). Phone: +351–224157100/+351–224157102. E-mail:
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Baddeley, A. D. (1986). Working memory. Oxford, UK: Clarendon Press.
Báez, S., Gleichgerrcht, E., Urquina, H., Lischinsky, A., Roca, M., Manes, F., & Torralva, T. (2011, May). Utility of the INECO Frontal Screening (IFS) for the detection of executive dysfunction in patients with adult ADHD and bipolar disorder. Paper presented at the Third International Congress on ADHD: From Childhood to Adult Disease. Berlin, Germany.
Barbosa, M., & Monteiro, L. (2008). Recurrent criminal behavior and executive dysfunction. The Spanish Journal of Psychology, 11, 259265.
Burgess, P. W., & Shallice, T. (1996). Bizarre responses, rule detection and frontal lobe lesions. Cortex, 32, 241259.
Caldeira, M. J. (2011). Adaptation and validation of INECO Frontal Screening (Master’s Thesis). Instituto Superior de Ciências da Saúde – Norte: Gandra, Portugal.
Carter, C. S., Barch, D. M., Bullmore, E., Breiling, J., Buchanan, R. W., Butler, P., … Wykes, T. (2011). Cognitive neuroscience treatment research to improve cognition in schizophrenia II: Developing imaging biomarkers to enhance treatment development for schizophrenia and related disorders. Biological Psychiatry, 70, 712.
Chan, R. C., Chen, E. Y., & Law, C. W. (2006). Specific executive dysfunction in patients with first-episode medication-naïve schizophrenia. Schizophrenia Research, 82, 5164.
Clark, L., & Manes, F. (2004). Social and emotional decision-making following frontal lobe injury. Neurocase, 10, 398403.
Clark, L., Manes, F., Antoun, N., Sahakian, B. J., & Robbins, T. W. (2003). The contributions of lesion laterality and lesion volume to decision-making impairment following frontal lobe damage. Neuropsychologia, 41, 1474–1183.
Cornblatt, B. A., Lenzenweger, M. F., Dworkin, R. H., & Erlenmeyer-Kimling, L. (1992). Childhood attentional dysfunction predicts social isolation in adults at risk for schizophrenia. The British Journal of Psychiatry, 161, 5968.
Crawford, J. (1998). Introduction to the assessment of attention and executive function. Journal of Neuropsychological Rehabilitation, 8, 209211.
Damasio, A. R. (1995). Toward a neurobiology of emotion and feeling: Operational concepts and hypotheses. The Neuroscientist, 1, 1925.
Davidson, M., Reichenberg, A., Rabinowitz, J., Weiser, M., Kaplan, Z., & Mark, M. (1999). Behavioral and intellectual markers for schizophrenia in apparently healthy male adolescents. The American Journal of Psychiatry, 156, 13281335.
Eisenberg, D. P., & Berman, K. F. (2010). Executive function, neural circuitry, and genetic mechanisms in schizophrenia. Neuropsychopharmacology, 35, 258277.
Eslinger, P. J., & Grattan, L. M. (1993). Frontal lobe and frontal-striatal substrates for different forms of human cognitive flexibility. Neuropsychologia, 31, 1728.
Ettlin, T., & Kischka, U. (1999). Bedside frontal lobe testing. The “frontal lobe score”. In Miller, B. L., & Cummings, J. L. (Eds.), The human frontal lobes. New York, NY: The Guilford Press.
Evans, J. J., Chua, S. E., McKenna, P. J., & Wilson, B. A. (1997). Assessment of the dysexecutive syndrome in schizophrenia. Psychological Medicine, 27, 635646.
Everett, J., Lavoie, K., Gagnon, J., & Gosselin, N. (2001). Performance of patients with schizophrenia on the Wisconsin Card Sorting Test (WCST). Journal of Psychiatry and Neuroscience, 26, 123130.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Freedman, D., & Brown, A. (2011). The developmental course of executive functioning in schizophrenia. International Journal of Developmental Neuroscience, 23 , 237243.
Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). BRIEF: Behavior rating inventory of executive function professional manual. Lutz, FL: PAR.
Goldberg, T. E., David, A., & Gold, J. M. (2003). Neurocognitive deficits in schizophrenia. In Hirsch, S. R., & Weinberger, D. R. (Eds.), Schizophrenia (pp. 168184). Oxford, UK: Blackwell Science.
Goldman-Rakic, P. S. (1994). Working memory dysfunction in schizophrenia. The Journal of Neuropsychiatry and Clinical Neurosciences, 6, 348357.
Graham, S., Phua, E., Soon, C. S., Oh, T., Au, C., Shuter, B., … Yeh, , I. B. (2009). Role of medial cortical, hippocampal and striatal interactions during cognitive set-shifting. NeuroImage, 45, 13591367.
Green, M. F., Kern, R. S., & Heaton, R. K. (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: Implications for MATRICS. Schizophrenia Research, 72, 4151.
Greve, K. W., Stickle, T. R., Love, J. M., Bianchini, K. J., & Stanford, M. S. (2005). Latent structure of the Wisconsin Card Sorting Test: A confirmatory factor analytic study. Archives of Clinical Neuropsychology, 20, 355364.
Groth-Marnat, G. (2000). Neuropsychological assessment in clinical practice: A guide to test interpretation and integration. Hoboken, NJ: Wiley.
Heinrichs, R. W., & Zakzanis, K. K. (1998). Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology, 12, 426445.
Ihara, H., Berrios, G. E., & McKenna, P. J. (2000). Dysexecutive syndrome in schizophrenia: A cross-cultural comparison between Japanese and British patients. Behavioral Neurology, 12, 209220.
Jansma, J. M., Ramsey, N. F., van der Wee, N., & Kahn, R. S. (2004).Working memory capacity in schizophrenia: A parametric fMRI study. Schizophrenia Research, 68, 159171.
Jonides, J., Schumacher, E. H., Smith, E. E., Koeppe, R. A., Awh, E., Reuter-Lorenz, P. A., … Willis, , , C. (1998). The role of parietal cortex in verbal working memory. The Journal of Neuroscience, 18, 50265034.
Keefe, R., Goldberg, T. E., Harvey, P. D., Gold, J. M., Poe, M. P., & Coughenour, L. (2004). The brief assessment of cognition in schizophrenia: Reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophrenia Research, 68, 283297.
Kerns, J. G., Nuechterlein, K. H., Braver, T. , S., & Barch, D. M. (2008). Executive functioning component mechanisms and schizophrenia. Biological Psychiatry, 64, 2633.
Koren, D., Seidman, L. J., Harrison, R. H., Lyons, M. J., Kremem, W. S., Caplan, B., … Tsuang, , M. T. (1998). Factor structure of the Wisconsin Card Sorting Test: Dimensions of deficit in schizophrenia. Neuropsychology, 12, 289302.
Krabbendam, L., Vugt, E., Derix, M., & Jolles, J. (1999). The Behavioral Assessment of the Dysexecutive Syndrome as a tool to assess executive functions in Schizophrenia. The Clinical Neuropsychologist, 13, 370375.
Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment (4 th Ed.). New York, NY: Oxford University Press.
Liddle, P. F., & Morris, D. L. (1991). Schizophrenic symptoms and frontal lobe performance. The British Journal of Psychiatry, 158, 340345.
Manes, F., Sahakian, B., Clark, L., Rogers, R., Antoun, N., Aitken, M., & Robbins, T. (2002). Decision-making processes following damage to the prefrontal cortex. Brain, 125, 624639.
Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “Frontal Lobe” tasks: A latency variable analysis. Cognitive Psychology, 41, 49100.
Norman, D. A., & Shallice, T. (1986). Attention to action: Willed and automatic control of behavior. In Davidson, R. I., Schwartz, G. E., & Shapiro, D. (Eds.), Consciousness and self−regulation: Advances in research and theory. New York, NY: Plenum Press.
Norris, G., & Tate, R. (2000). The Behavioral Assessment of the Dysexecutive Syndrome (BADS): Ecological, concurrent and construct validity. Neuropsychological Rehabilitation, 10, 3345.
Palmer, B. W., & Heaton, R. K. (2000). Executive dysfunction in schizophrenia. In Sharma, T. & Harvey, P. D. (Eds.), Cognition in schizophrenia: Impairments, importance and treatment strategies (pp. 5172). New York, NY: Oxford University Press.
Palmer, C., Heiby, E., Fujii, D., & Kameoka, V. (2008). Executive functioning in schizophrenia: The contributions of attention, working memory, processing speed, and general intelligence. Graduate Student Journal of Psychology, 10, 3845.
Reeder, C., Newton, E., Frangou, S., & Wykes, T. (2004). Which executive skills should we target to affect social functioning and symptom change? A study of a cognitive remediation therapy program. Schizophrenia Bulletin, 30, 87100.
Rothlind, J. C., & Brandt, J. (1993). A brief assessment of frontal and subcortical functions in dementia. Journal of Neuropsychiatry and Clinical Neurosciences, 5, 7377.
Royall, D. R., Mahurin, R. K., & Gray, K. F. (1992). Bedside assessment of executive cognitive impairment: The executive interview. Journal of American Geriatrics Society, 40, 12211226.
Shallice, T. (1988). From neuropsychology to mental structure. Cambridge, UK: Cambridge University Press.
Shallice, T., & Burgess, P. W. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114, 727741.
Snitz, B. E., Macdonald, A. W., & Carter, C. S. (2006). Cognitive deficits in unaffected first-degree relatives of schizophrenia patients: A meta-analytic review of putative endophenotypes. Schizophrenia Bulletin, 32, 179194.
Strauss, E., Sherman, E., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms and commentary. (3 rd Ed.). Oxford, UK: Oxford University Press.
Stuss, D. T., Alexander, M. P., Shallice, T., Picton, T. W., Binns, M. A., Macdonald, R., … Katz, D. I. (2005). Multiple frontal systems controlling response speed. Neuropsychologia, 43, 396417.
Stuss, D. T., & Benson, D. F. (1986). The frontal lobes. New York, NY: Raven Press.
Szöke, A., Schurhoff, F., Mathieu, F., Meart, A., Ionescu, S., & Lebover, M. (2005). Tests of executive functions in first-degree relatives of schizophrenic patients: A meta-analysis. Psychological Medicine, 35, 771782.
Tanibuchi, I., & Goldman-Rakic, P. S. (2003). Dissociation of spatial-, object-, and sound-coding neurons in the mediodorsal nucleus of the primate thalamus. Journal of Neurophysiology, 89, 10671077.
Torralva, T., Kipps, C. M., Hodges, J. R., Clark, L., Bekinschtein, T., Roca, M., … Manes, , , F. (2007). The relationship between affective decision-making and theory of mind in the frontal variant of frontotemporaldementia. Neuropsychologia, 45, 342349.
Torralva, T., Roca, M., Gleichgerrcht, E., López, P., & Manes, F. (2009). INECO Frontal Screening (IFS): A brief, sensitive, and specific tool to assess executive functions in dementia. Journal of the International Neuropsychological Society, 15, 777786.
Wilson, B. A., Alderman, N., Burgess, P. W., Emslie, H. E., & Evans, J. J., (1996). Behavioral assessment of the dysexecutive syndrome. Suffolk, UK: Thames Valley Test Company.
Wilson, B. A., Evans, J. J., Emslie, H., Alderman, N., & Burgess, P. (1998). The development of an ecologically valid test for assessing patients with a dysexecutive syndrome. Neuropsychological Rehabilitation, 8, 213228.
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