Clinical utility of the INECO Frontal Screening for detecting Mild Cognitive Impairment in Parkinson’s disease

Abstract

Cognitive deficits in Parkinson’s disease typically affect executive functions. Recently, the concept of Mild Cognitive Impairment (MCI) has been related to PD (PD-MCI). PD-MCI is considered a transition phase to Parkinson’s disease Dementia. Therefore, it is important to identify PD-MCI in a reliable way. Objective: To evaluate the sensitivity and specificity of the INECO Frontal Screening (IFS) in detecting cognitive deficits in PD-MCI. Additionally, we compare the IFS and the Addenbrook Cognitive Examination Revised (ACE-R) between three groups; PD-MCI, MCI, and controls. Methods: The IFS and ACE-R were administered to 36 patients with PD-MCI, 31 with MCI (amnestic-multidomain subtype) and 92 healthy controls. Sensitivity and specificity were determined using ROC analysis. The groups were compared using one-way analysis of variance. Results: The IFS had adequate accuracy in differentiating patients with PD-MCI from healthy controls (AUC=0.77, sensitivity=0.82, specificity=0.77), and good accuracy in differentiating PD-MCI from MCI patients (AUC=0.80, sensitivity=0.82, specificity=0.61). However the IFS had low accuracy in differentiating MCI patients from healthy controls (AUC=0.47, sensitivity=0.52, specificity=0.41). On the ACE-R, the PD-MCI group had low performance in Fluency and Language. Only patients with PD-MCI had difficulties on the IFS, specifically in inhibitory control and visual working memory. This dysexecutive profile explains the sensitivity and specificity values found in the IFS. Conclusion: The present study results suggest that the IFS is a suitable screening tool for exploring cognitive dysfunction in PD-MCI, especially in those patients with a dysexecutive profile.

Evaluation of sensitivity and specificity of the INECO Frontal Screening and the Frontal Assessment Battery in mild cognitive impairment

“…In the specific case of Cuba, we did not find any previous study that explored the clinical utility of FAB; conversely, to date, only one study in the country has investigated the sensitivity and specificity of IFS in detecting cognitive deficits in MCI patients (md-aM-CI). 17 Contrary to results of the present study, the previous study showed that IFS had a low capacity for discriminating between md-aMCI patients and healthy controls. This discrepancy accounts for differences in the cognitive profiles of the MCI patients included in both studies.…”

“…This discrepancy accounts for differences in the cognitive profiles of the MCI patients included in both studies. In the study conducted by Broche-Pérez et al 17 the md-aMCI patients did not differ from healthy controls in the following subtests: Conflicting instructions (sensitivity to interference), Months backward, and Digit Span Task (working memory). In this sense, the md-aMCI patients of the present study show a greater executive deficit, which increases the sensitivity of IFS.…”

“…On the other hand, IFS is a brief neuropsychological test designed to explore executive functions across neurodegenerative pathologies such as AD, 13 behavioral variant frontotemporal dementia, 14 Multiple Sclerosis (relapsing-remitting phase), 15 MCI, 16 and MCI in Parkinson's disease. 17 IFS is composed of eight subtests, organized into three main executive domains: 18 1) inhibition and change, 2) working memory, and 3) capacity for abstraction.…”

Semantic Memory and Lexical Availability in Parkinson’s Disease: A Statistical Learning Study

“…The maximum total score in the ACE-R is 100 points (see Supplementary Section 1). Furthermore, subjects' executive functioning was examined through the INECO Frontal Screening (IFS) (Torralva et al, 2009), a validated test to measure executive dysfunction in neurodegeneration (Gleichgerrcht et al, 2011;Broche-Pérez et al, 2019;Moreira et al, 2019). This test comprises the following eight subtests: (1) motor programming (Luria series, "fist, edge, palm"); (2) conflicting instructions (hitting the table once when the administrator hits it twice, or hitting it twice when the administrator hits it only once); (3) motor inhibitory control; (4) numerical working memory (backward digit span);…”

Utility of the INECO Frontal Screening and the Frontal Assessment Battery in detecting executive dysfunction in early-onset cognitive impairment and dementia

“…To identify neuropsychological profiles with a prominent ED, it may be relevant to measure executive functions in more detail, as evidence has shown that a method specifically designed for detecting ED can better identify patients with dysexecutive profiles than general screening methods (Broche-Pérez et al, 2019; Fiorentino et al, 2013). Related to this, the Frontal Assessment Battery (FAB; Dubois et al, 2000) and the Institute of Cognitive Neurology (INECO) Frontal Screening (IFS; Torralva et al, 2009) are tools designed to assess executive functions and may be particularly useful in the early detection of EOD, especially considering the prominence of ED in EOD.…”