INECO FRONT SCREENING (IFS) MINECO

STUDY CENTER OF THE

MEMORY AND BEHAVIOR

Administration and Scoring Manual

Goals

The objective of the creation of this tool is the detection of executive dysfunction in patients with
various pathologies that affect the frontostriatal circuits, and to provide health professionals with
an executive screening instrument that is sensitive and specific, and at the same time short and
easily administered to determine executive dysfunction in patients with various types of dementia
or other psychiatric diseases.

The design of the IFS was primarily conceived, representing three groups of cognitive tasks, as
indicated below: (a) response inhibition and set switching – evaluates the ability to switch from
one cognitive set to another, and to inhibit inappropriate responses in a manner verbal and motor;
(b) abstraction capacity – obtained from the interpretation of proverbs, the concrete interpretation
being typical of patients with damage to the frontal lobe; (c) working memory – refers to a brain
system that provides temporary storage and manipulation of information necessary for other
complex cognitive tasks.

Background

The Frontal Assessment Battery (FAB) (Dubois, Slachevsky, Litvan & Pillon) consists of 6
subtests that assess conceptualization, cognitive flexibility, motor programming, sensitivity to
interference, inhibitory motor control, and prehension behavior. The authors propose the
administration of this battery for the evaluation of different types of frontal dysfunctions, and
also to distinguish between neurological pathologies such as the behavioral variable of
Frontotemporal Dementia and Alzheimer's Disease (Slachevsky et al., 2004). These authors
report correlations with classic executive tests such as the Wisconsin Card Sorting Card (WSCT)
and with measures of general cognitive functioning (Mattis Dementia Scale), while they highlight
the lack of correlation with the Mini Mental State Examination (MMSE). The authors conclude
that the FAB battery is an easy tool to administer, and sensitive to executive dysfunction. On the
contrary, other studies have raised doubts regarding the sensitivity and specificity of the FAB,
and in particular, its ability to differentiate different types of dementia such as Alzheimer's
Disease and Frontotemporal Dementia (Castiglioni et al., 2006; Lipton et al. , 2005) in its early

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stages.

To create the IFS we incorporated some subtests of the FAB that demonstrated the highest
sensitivity in our daily clinic: programming of motor series, conflicting instructions and
inhibitory control. Of these included subtests, motor programming has been shown to have the
highest sensitivity in a study conducted by Lipton et al. (2005), while conflicting instructions and
inhibitory control are, in our experience, two subtests that usually generate difficulties for our
frontal patients.

To create a more sensitive and specific tool, we also included new subtests that have been shown
in various research studies to be sensitive to executive dysfunction: numerical working memory
(Digits in reverse order), verbal working memory (Months in reverse order). , spatial working
memory (Modified version of the Corsi Tapping Test), conceptualization (proverbs), and verbal
inhibitory control (Modified version of the Hayling Test; Burgess & Shallice).

Statistical References

The suggested cut-off point for the IFS is 25 points, having demonstrated a sensitivity of 96.2%
and a specificity of 91.5% in the differentiation of patients with various types of dementia.

Administration

The IFS is made up of 8 subtests:

1. Motor Series (Dubois et al., 2000)

In this subtest, the patient is asked to perform the Luria series: “Fist, Song,
Palm,” initially copying the administrator, and then repeating the series for
himself 6 times.

Instruction: “Look carefully at what I'm doing (making the Luria series). Now
you do the same with your right hand, first with me, and then you alone . ”
Repeat the series 3 times with the patient and then say “ Now do it yourself . ”

2. Conflicting Instructions (Dubois et al., 2000)

Subjects are asked to hit the table once when the manager hits it twice, and to
hit it twice when the manager hits it once. To ensure that the subject has
correctly understood the instructions, a practice trial is carried out in which the
administrator hits the table once, three consecutive times; and then twice, three
times more. After the practice trial, the examiner completes the following series:

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 1-1-2-1-2-2-2-1-1-2.

Instruction: “ Hit the table twice when I hit you once .” To make sure the subject
has understood, tap the table once. Repeat it 3 times. “ Now hit the table once
when I hit it twice.” To ensure that the subject has understood the message, tap
the table twice. Repeat it 3 times. Now perform the series 1-1-2-1-2-2-2-1-1-2.

3. Go-No Go (Dubois et al., 2000)

This test must be administered immediately after test b. The subjects are
instructed that now when the administrator hits the table once, they should hit it
once, and when the administrator hits it twice they should not hit it. To ensure
that the subject understood the instructions correctly, a practice trial was carried
out in which the administrator hit the table once, three consecutive times; and
then twice, three times more. Once the practice trial is finished, the following
series is administered: 1-1-2-1-2-2-2-1-1-2.

Instruction: “ Hit the table once, when I hit it once.” To make sure the subject
has understood, tap the table once. Repeat it 3 times. “ Now don't hit when I hit
twice.” To ensure that the subject has understood the message, tap the table
twice. Repeat it 3 times. Now perform the following series: 1-1-2-1-2-2-2-1-1-2.

4. Digits in reverse order (Hodges, 1994)

In this test, the examiner reads a series of numbers. In each item the subject is
asked to repeat the series in reverse order. Read the digits one at a time,
lowering your voice slightly on the last digit in the series. If the subject
correctly repeats any of the two trials of each trial, the next trial is administered.
Discontinue after scores of 0 on both attempts of any item.

Instruction: “ I am going to tell you some digits and, when I finish, repeat them
backwards and forwards. For example, if I say 7-1-9, what would you have to
say?” . If the subject answers the grouped numbers, he or she is asked to do so
one at a time.

5. Verbal Working Memory (Hodges, 1994)

The subject is asked to list the months of the year in reverse order, starting with
December. This subtest evaluates the same function as the previous test, but
with the difference that the series is highly known by all people.

Instruction: “ Say the months of the year in reverse order, starting with the last
month of the year.”

6. Spatial Working Memory (Weschler, 1987)

In this test, the examiner presents the subject with four squares, which he points
to following a certain sequence. The subject is asked to repeat the sequence in

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 reverse order. There are four trials performing a sequence of 2, 3, 4 and 5
squares respectively.

Instruction: “ I am going to point out the squares in a certain order. I want you
to point them out in reverse order.” Do it slowly. The patient can choose the
hand of preference.

7. Capacity for Abstraction (Interpretation of proverbs) (Hodges, 1994)

This test was chosen to integrate this battery since patients with frontal lesions
usually present difficulties in moving away from the literal or concrete content
of the sentence to find its abstract meaning. In this test, three proverbs are read
to the subject and they are asked to explain their meaning. For this population, 3
proverbs were chosen based on their frequency of use in oral language.

Instruction: “ Now I am going to read you a saying, and I would like you to
explain its meaning to me.” The first proverb is read and only on the first
occasion, if the patient presents a concrete explanation of it, is he or she asked
to provide an explanation beyond the concrete meaning. Example: “Dog that
barks does not bite” ; If the patient says: “When the dog is tied he cannot bite,”
he is told: “ Beyond the dog, what would be the meaning of this saying?” .

8. Verbal Inhibitory Control (Burgess & Shallice, 1997b)

This task, inspired by the Hayling Test, measures a subject's ability to inhibit an
expected response. The task consists of six sentences with the last word missing
and which are constructed in such a way that the correct option is strongly
suggested by the context of the sentence.
The first part consists of three sentences which are read to the subject; they are
asked to complete them, as quickly as possible, so that the sentence is correct.
The second part also consists of three sentences in which the last word is
missing, but in this part the subject must complete it with a word that is
syntactically correct, but that has no relation to the meaning of the sentence.

Instruction : Phase 1 “ Listen carefully to these sentences and as soon as you

finish reading them, you must tell me, as quickly as possible, what word
completes the sentence . ” Read the 3 sentences.
Phase 2: “This time, I want you to tell me a word that does not make any sense
in the context of the sentences, and that is not related to the word that would
correctly complete the sentence.” Read the example “ For example: Daniel hit
the nail with the... rain ”. Start with the first sentence. If the subject responds
with a semantically close word, he or she is asked to try another word that is
more distant. If you are unable to find it, the examiner may suggest an answer.
If during the course of the test, it is observed that the subject continues to
complete the sentences with related words, the examiner must suspend the test
and repeat the instruction. If the subject does not produce a response for 60
seconds, the trial is terminated and the next stimulus is moved on. Repetition

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 strategies should be discouraged each time the subject uses them.

Punctuation

Motor Series (3 points): If the subject completes six consecutive series by himself, the score
awarded is 3 points. If you perform at least three consecutive sets alone, the score awarded is 2
points. If they cannot perform at least three consecutive series by themselves, but can perform it
correctly by copying the administrator, the score awarded is 1 point, otherwise it is 0.

Conflicting Instructions (3 points): If the subject did not make any errors, then the score
awarded is 3 points. If they made one or two errors, the score awarded is 1 point. If the subject
copied the administrator at least four consecutive times, the score awarded is 0 points.

Go-No Go (3 points): If the subject did not make any errors, then the score awarded is 3 points.
If they made one or two errors, the score awarded is 1 point. If the subject copied the
administrator at least four consecutive times, the score awarded is 0 points.

Digits in Reverse Order (6 points): The score is equivalent to the number of correct numbers
that the subject has said in any of the two trials.

Verbal working memory (2 points): If the subject does not make errors, then the score awarded
is 2 points. If you make a mistake, the score awarded is 1 point. Otherwise, it is 0 points.

Spatial working memory (4 points): The number of trials performed correctly is scored.

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Abstraction Capacity (Interpretation of proverbs) (3 points): For each proverb, 1 point is
awarded if the subject provided an adequate explanation of the proverb. If the subject provides a
correct example, the score awarded is 0.5, otherwise it is 0.

Verbal Inhibitory Control (6 points): only the second part is scored. For each sentence a score
of two points is assigned if the word is not related to the sentence. A score of one is assigned if
the word is semantically related to the word that would correctly complete the sentence, and a
score of 0 if it uses the expected word. (a table for correct punctuation is attached).

Supplementary table for the correct scoring of verbal inhibitory control responses.

Response Type Criterion Score

Completely related
word
Word that coherently completes the sentence. 0

Omission without response for the item within 60 seconds.

Omission 0

Word with the opposite meaning to that which coherently

completes the sentence. 1

Word semantically related to sentence subject or verb

1
Word with some
relationship Word semantically related to the word that coherently
completes the sentence 1

Word related to prayer in a playful or metaphorical way.

1

Word not semantically related to the sentence but

corresponding to an object present in the context and visible
2
to the subject

Word not semantically related to the sentence but which is a

repetition of a response or previous stimuli.
2

Unrelated word
Word not semantically related to the sentence and not
morphologically related (does not respect morphological
2
agreement)

Unrelated word (it is not semantically related, it is not

repetition, nor does it refer to an object present in the
2
context).

Abusamra, V., Miranda, M.A., & Ferreres, A. (2007). Modified.

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If you have any questions or queries, please contact Teresa Torralva:

ttoralva@ineco.org.ar

1
0
 INECO FRONT SCREENING
MOTOR SERIES Yo /3
"Look carefully at what I 'm doing . " The examiner performs Luria 's series three times . song, palm". Now do the same with your hand : ha. First with me and then you
will." The examiner performs the series 3 times with the patient and then says it . "Wshore, do it yourself."
Score : Consecutive series only: 3 / at hands 3 consecutive series = only : 2 / The patient fails in 1 arrest achieves 3 consecutive series with the examiner: 1 / The
patient does not achieve 3 consecutive series with the examiner : 3
CONFLICTING INSTRUCTIONS | /3
"Strike twice when I strike once." To ensure that the patient understood the instructions correctly, perform a series of 3 tests: 1 1- 1. " "I hit Pee once when I hit Peo
twice." To ensure that the patient understood the instructions well . _ _ _ _ perform a series of 3 tests: 2-2-2. The examiner performs the following series: 1-1-2-1-2- 2-
2-1-1- 2. Score: No error: 3/ One or two errors: 2/ More errors : 1/ The patient hits like the examiner at least 4 consecutive times: 0

ENGINE INHIBITORY CONTROL | /3

" I hit Pee once when I hit Peo once ." To ensure that the patient understood the instructions well . perform a series of 3 tests: 1-1 1. " "I don't hit pee when I hit peo
twice." To ensure that the patient understands the instructions well . _ _ Perform a series of 3 tests : 2- 2- 2. The examiner performs the following series : 1-1-2-1-2- 2-
2- 1-1- 2 . Score: 5 Error : 3 / One or two errors: 2 / More than two errors : 1 / The patient hits the examiner at least 4 consecutive times 0

REPEAT DIGITS BACK /6

2-4 5-7
6-2-9 4-1-5
3-2-7-9 4-9-6-8
1-5-2-8-6 6-1-84-3
5-3-94-1-8 7-24-8-5-6
8-1-2-9-3-6-5 4-7-3-9-1-2-8
94-3-7-6-2-5-8 7-2-8-1-9-6-5-3
MONTHS AGO /2
December November October September August July
June May April March February January
VISUAL WORKING MEMORY /4
1-2 34-2-1
24-3 14-2-34
Point to the cubes in the order indicated, the patient must copy this sequence of movements in reverse order. Do it slowly: the patient decides which hand they prefer to
use.
SAYINGS /3
Dog that barks, does not bite Those who talk a lot usually do little.
In bad weather, good face Take a positive attitude in the face of adversity
In the blacksmith 's house , a wooden knife Lacking something when, due to your profession or job, you should not lack it
Example: V2 point. Correct Explanation: 1 Point.
VERBAL INHIBITORY CONTROL /6
Initiation
I put on my shoes and tie them
They fought like hell and
Inhibition
Juan bought candy at the
An eye for an eye and a client for
Wash clothes with water and

TOTAL IFS:

1
1
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