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5 Cognitive Rehabilitation Using Teleneuropsychology. A Cohort Study in South America
- Carlos Martinez Canyazo, Rodrigo S Fernandez, Maria B Helou, Micaela Arruabarrena, Nicolas Corvalan, Agostina Carello, Paula Harris, Monica Feldman, Ismael Luis Calandri, Maria E Martin, Ricardo F Allegri, Lucia Crivelli
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 209
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Objective:
The COVID-19 pandemic has affected the continuity of cognitive rehabilitation (CR) worldwide. However, the use of teleneuropsychology (TNP) to provide CR has contributed significantly to the continuity of treatment. The objective of this study was to measure the effects of CR via the TNP on cognition, neuropsychiatric symptoms, and memory strategies in a cohort of patients with Mild Cognitive Impairment (MCI).
Participants and Methods:A sample of 60 patients (60% female; age: 72.4±6.96) with MCI according to Petersen criteria was randomly divided into two groups: 30 cases (treatment group) and 30 controls (waiting list group). Subjects were matched for age, sex, and MMSE or MoCA.
The treatment group received ten weekly CR sessions of 45 minutes weekly. Pre-treatment (week 0) and post-treatment (week 10) measures were assessed for both groups. Different Linear Mixed Models were estimated to test treatment effect (CR vs. Controls) on each outcome of interest over Time (Pre/Post), controlling for Diagnosis, Age, Sex, and MMSE/MoCA performance.
Results:A significant Group (Control/Treatment) x Time (pre/post) interaction revealed that the treatment group at 10 weeks had better scores in cognitive variables: memory (RAVLT learning trials p=0.030; RAVLT delayed recall p=0.029), phonological fluency(p=0.001), activities of daily living (FAQ p=0.001), satisfaction with memory performance (MMQ Satisfaction p=0.004) and use of memory strategies (MMQ Strategy p=0.00), and a significant reduction of affective symptomatology: depression (GDS p=0.00), neuropsychiatric symptoms (NPIQ p=0.045), Forgetfulness (EDO-10 p=0.00), Stress (DAS Stress p=0.00).
Conclusions:This is the first study to test CR using teleNP in South America. Our results suggest that CR through teleNP is an effective intervention to improve performance on cognitive variables and reduce neuropsychiatric symptomatology compared to patients with MCI. These results have great significance in the context of the COVID-19 pandemic in South America, where teleNP is proving to be a valuable tool.
37 Adherence to treatment in Multiple Sclerosis. The importance of personality, executive functions, and social support
- Carlos Alberto Martinez Raudeberg, Lucia Crivelli, Ismael Calandri, Micaela Arruabarrena, Maria Agustina Piedrabuena, Maria Agustina Piedrabuena, Maria Celica Ysrraelit, Ricardo Allegri, Jorge Correale
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 551-552
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Objective:
To test whether adherence to treatment in patients with MS is influenced by cognitive variables (executive functions), personality, and social support.
Participants and Methods:This is a pilot observational, descriptive, cross-sectional study. 60 patients with Relapsing remitting MS ( 73.33% female; age: 41.41 ±14.00) undergoing medical treatment ( 28 dymethilfumarate, 7 ocrelizumab/ rituximab, 6 fingolimod, 5 interferon, 5 natalizumab, 4 cladribine, 3 teriflunomide, 1 alemtuzumab, 1 glatiramer acetate) underwent a comprehensive multi-component evaluation including : cognition, social support (using the self-reported record of social support scale), personality (using the NEO-FFI questionnaire) and evaluation of treatment adherence using the Morisky Green Levine Medication Adherence Scale Participants were divided into two groups according to their adherence to medical treatment, low vs. high adherence was defined using a cutoff score of 4. Differences between groups were evaluated using Student's t-test with a significance level of p<0.05, the effect size was calculated with Cohen's d test.
Results:Groups did not differ significantly in age, sex, type of treatment, Montreal Cognitive Assesments (MoCA) or neuropsychiatric scales of depression and anxiety. Regardless of treatment type, 63.33% of the patients had high treatment adherence. Significant differences between groups were found in the Global Index of Social Support (p=0.016, Cohen's d= 0.73) and the responsibility factor of the NEO-FFI (p=0.048, Cohen's d= 0.20). Conversely, no significant differences were found in executive functions (p=0.8), Openness (p=0.062), Extraversion (p=0.5), Neuroticism (p=0.4) and Agreeableness (p=0.8).
Conclusions:Social support and the responsibility factor of personality are significantly different between MS patients with high and low adherence to medical treatment. The study of social support and personality may be a key component in improving adherence strategies.
Poster Symposium: Digital Neuropsychology in Perspective: Are we 'Clinically’ there yet?
- Lucia Crivelli, Preeti Sunderaraman
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 770
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Traditionally, neuropsychology has focused on assessing aspects of the brain and behavior using in-person, paper-and-pencil tests. There was a heavy emphasis on the standardization of test procedures and use of psychometrically sound norms to enable precise clinical evaluations and diagnosis. In the past few decades, the advent of digital technology has led to an increased focus on teleneuropsychology, which consists of conducting evaluations remotely. The coronavirus (COVID) pandemic propelled teleneuropsychology to new heights as it became increasingly recognized that cognitive evaluations conducted via technology can be both a feasible and practical approach to understanding the brain. However, with this realization, it also became apparent that teleneuropsychology tests and procedures need to be updated to keep pace with the contextual changes. In keeping with this need the current symposium includes four abstracts covering a range of topics relevant to improve our understanding of the future of teleneuropsychology and its emergent clinical applications. The first abstract focuses on providing the audience with a scoping review of the literature about the current state of teleneuropsychology following the COVID pandemic. The second abstract focuses on providing evidence for the feasibility of conducting cognitive assessments remotely along with providing construct validity for the tasks. The third abstract discusses a rapid approach to test development, piloting, translation to clinical use, and adaptation for other languages and cultures using a unique platform. Finally, the last abstract focuses on improving our understanding of a Hybrid Neuropsychology model that integrates various digital tools for neuropsychological use that is being implemented in a clinical setting.
86 Dementia Caregiver Burden associated with COVID-19 quarantine: A South American Cohort Study
- Micaela María Arruabarrena, Rodrigo Fernandez, Carlos Alberto Martinez Canyazo, Nicolas Corvalan, Greta Keller, Agostina Carello, Gustavo Emilio Sevlever, Ricardo Francisco Allegri, Lucía Crivelli
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 388-389
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Objective:
The objective of this study is to explore the impact on the mental health of caregivers of people with dementia during the period of mandatory preventive social isolation (ASPO) and to study which of these factors were predictors of caregiver overload.
Participants and Methods:During the first 3 months of the ASPO (June 2020 to september 2020). A sample of 112 caregivers (75.89% female; age 58.65 ± 14. 30) of patients with dementia from a Memory Center answered, remotely (online or telephone) a survey with the following questionnaires: the Zarit Caregiver Overload Scale (ZBI), Weekly hourly load dedicated to the care of patients with dementia), the use of time in unpaid activities through an activity diary, provided by Argentine National Institute of Statistics and Census (INDEC), the Caregiver Activities Survey (CAS) and the Anxiety, Depression and Stress Scale (DASS-21). These questionnaires evaluate the conditions and characteristics of caregiving tasks and their impact on the caregiver in the context of ASPO. Additionally, it was recorded whether the person with dementia, the caregiver, or persons living with them had had COVID-19.
Results:Descriptively, a disparity in frequency was observed in the gender of caregivers of persons with dementia, i.e., caregiving is inequitably distributed between men (24.11%) and women (75.89%). This difference hinders direct comparison between men and women. A regularized L2 regression was performed for the identification of predictors of caregiver overload identifying the number of caregiving hours (β=0.090), DAS depression (β=0.085), DASS anxiety (β=0.099) DASS stress (β=0.164), fear of Covid (0.141) and lower patient cognitive performance according to MMSE (β=-0.41) and to lesser extent sex as the greatest contributors to patient overload. Additionally, a mediation analysis was performed in which the factors number of caregiving hours (CAS; r= 0.254,r= 0.292,r= 0.252,r= 0.252,r= -0.37), being a primary caregiver and fear of Covid-19 (r= 0.335,r= 0.432,r= 0.402,r= -0.496) were found to be mediators of the effect between anxiety, depression, stress (DASS) and overload (ZBI).
Conclusions:Caregivers of patients with dementia have suffered sequelae such as anxiety, stress, depression, and overload (caregivers’ burden) in the context of the COVID-19 virus spread and during mandatory preventive social isolation. Being a primary caregiver, dedicating more hours to caregiving, and fear of Covid-19 are factors that contribute significantly to caregiver burden and mediate between this burden and mood variables. Public policies to support caregivers and information about the disease could modify these variables and reduce caregiver burden.
14 Title: Design of a neuropsychological battery for the detection of cognitive deficits in asymptomatic patients with low-grade glioma: a pilot study
- Greta Keller, Maria Agostina Carello, Vanina Banjsak, Noelia Egido, Ismael Luis Clandri, Ricardo Allegri, Andres Cervio, Lucia Crivelli Fleni
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 805-806
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Objective:
Gliomas are a group of CNS neoplasms arising from neuroglial cells with various degrees of aggressiveness. Resection of brain tumors is complex to perform without neurological sequelae due to the diffuse nature of the tumors. This study aimed to design a neuropsychological battery to examine pre surgical cognitive deficits in a case series of patients with LGG and to determine the post-surgical effects after resection.
Participants and Methods:11 adult patients aged 19-65 years (38 ±DS:15.5) with a diagnosis of LGG without cognitive complaint were evaluated with a selection of specific neuropsychological tests to identify possible baseline cognitive deficits and their evolution after tumor resection. All participants completed a comprehensive neuropsychological evaluation assessing memory, language, attention, executive functions, visuospatial functions, social cognition, praxis, agnosias, functionality, mood, and quality of life. The neuropsychological battery design was based on a systematic review of the literature on surgical interventions in low-grade gliomas.
Results:Despite not reporting subjective cognitive complaints, patients showed deficits in multiple cognitive domains in the pre-surgical evaluation when comparing their performance with normative values adjusted for age, sex, and education. Deficits in executive functions and attention were observed: 36% presented failures in graphomotor speed (TMT A), 27% of subjects presented failures in attentional span (Direct Digit Span), working memory (Inverse Digit Span), and cognitive flexibility (Wisconsin Card Sorting Test) and 9% presented difficulties in processing speed (Trail Making Test A) and inhibitory capacity (Stroop Test). Memory: 18% of the patients showed deficits in immediate logical memory and 9% in delayed memory (Craft Story 21). Likewise, 18% of the patients presented compromise in immediate auditory-verbal learning and 27% in delayed auditory-verbal learning (Rey Auditory-Verbal Test). Language: 18% showed failures in naming (Boston 60) and 9% in comprehension (Token Test). Likewise, 27% of the patients presented difficulties in social cognition (Mind in the Eyes Test). Finally 41% of the patients reported symptoms of depression and/or anxiety in the neuropsychiatric questionnaires.
Conclusions:The results highlight the importance of strategically designed pre-surgical cognitive assessment for the detection and follow-up of cognitive and mood disorders associated with the location of the space-occupying lesion (LOE). The patients assessed in this study will be evaluated three months after surgery to document changes in baseline cognitive symptoms. Furthermore, in patients with lesions in the left hemisphere, an intraoperative evaluation will be performed to minimize subsequent deficits, assessing these functions during surgery and emphasizing language.
38 Craft Story 21, Argentine Baremization of a Memory test and Design of a Recognition Instance.
- Maria Agostina Carello, Nicolas Corvalän, Greta Keller, Micaela Maria Arruabarrena, Cecilia Palermo, Carlos Alberto Martinez Canyazo, Ismael Luis Calandri, Ricardo Francisco Allegri, Lucia Crivelli
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 718-719
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Objective:
Craft Story 21 is a practical, comprehensive, and freely available tool to assess logical memory in patients with memory impairment. Currently, the test does not have normative values in Spanish that adjust to our specific population. Furthermore, the original test does not have a recognition phase to increase the specificity of the memory profile by allowing a distinction between different amnesic profiles. Therefore, this study has two main aims: 1) the generation of normative data for the Craft Story 21 memory test, adjusting to the characteristics of our Spanish-speaking country according to sex, age, and educational level; and 2) the design and validation of the recognition phase of the test and the assessment of its psychometric properties.
Participants and Methods:The baremization sample comprised 81 healthy participants aged 41 to 91, assessed through the Uniform Data Set III (UDS III) battery of the National Alzheimer’s Coordinating Center (NACC). The design of the recognition phase included three steps: (1) construction of the scale and review by experts, (2) pilot study, and (3) analysis of its psychometric properties. In the latter, 190 participants were recruited and classified into two groups matched by age, sex, and educational level: Mild Cognitive Impairment (MCI n=96) according to Petersen’s (1999) criteria and healthy controls (HC n=94). In addition, the diagnostic accuracy of the test was studied by the ROC curve method, its concurrent validity by correlation with other memory tests (RAVLT), and its internal consistency with Cronbach’s alpha test.
Results:The Baremization sample was divided into 16 groups: 4 age groups (41-51, 51-61, 6171 and >72 years), two educational levels (6-12 years and >12 years), and sex (male and female). Performance was significantly different between age groups (p < 0.003**). No significant differences were found in Craft Story 21 performance between education (p > 0.09) or sex (p > 0.56) groups within the same age group. Normative values in terms of means and standard deviations are presented for each group. Regarding the design of the recognition phase, the groups did not show significant differences in age (p= 0.13), sex (p= 0.88), or schooling (p= 0.33). The overall score of Craft Story 21 test showed the ability to discriminate between healthy controls from patients with MCI (sensitivity = 81.6% and specificity = 72.4%). Its diagnostic accuracy by phase (immediate AUC= 0.86; delayed AUC= 0.86 and recognition AUC= 0.75) was superior than Rey Auditory and Verbal Learning Test (RAVLT): immediate (AUC= 0.79), delayed (AUC= 0.82) and recognition (AUC= 0.74). It presented evidence of concurrent validity with RAVLT in its immediate (r=0.56, p<0.001), delayed (r= 0.66, p<0.001) and recognition (r= 0.37, p<0.001) trails. The instrument also presented evidence of reliability (a= 0.82).
Conclusions:The Craft Story 21 test is a practical, brief and multicultural scale. Thus having appropriate scales for the specific population to be assessed to a more accurate and precise description of the memory profile. Additionally, the new Recognition phase of the test showed evidence of validity and reliability for assessing memory processes.
Alerting Network Dysfunction in Early Multiple Sclerosis
- Lucía Crivelli, Mauricio F. Farez, Claudio D. González, Marcela Fiol, Alejandra Amengual, Ramón Leiguarda, Jorge Correale
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- Journal of the International Neuropsychological Society / Volume 18 / Issue 4 / July 2012
- Published online by Cambridge University Press:
- 24 May 2012, pp. 757-763
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The objective of this study is to assess attention in recently diagnosed relapsing-remitting multiple sclerosis patients. Twenty-seven patients with early multiple sclerosis and low clinical disability scores (EDSS<2) and 27 sex-, age-, and education-matched healthy controls underwent attention assessment using the Attentional Network Test, a computerized task designed to measure efficiency independently in 3 attentional networks (Alerting, Orienting and Executive Control). MS patients had significantly less efficiency in the Alerting network (p = .006). In contrast, in the Orienting and Executive Control networks, they did not differ from controls. A significant interaction between Alerting and Executive Control was also found in the MS patients (p = .007). Early relapsing-remitting multiple sclerosis particularly affects the Alerting domain of attention, whereas the Orienting and Executive Control domains are not affected. (JINS, 2012, 18, 1–7)