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Valles-Salgado M, Matias-Guiu JA, Delgado-Álvarez A, Delgado-Alonso C, Gil-Moreno MJ, Valiente-Gordillo E, López-Carbonero JI, Fernández-Romero L, Peña-DeDiego L, Oliver-Mas S, Matías-Guiu J, Diez-Cirarda M. Comparison of the Diagnostic Accuracy of Five Cognitive Screening Tests for Diagnosing Mild Cognitive Impairment in Patients Consulting for Memory Loss. J Clin Med 2024; 13:4695. [PMID: 39200837 PMCID: PMC11354893 DOI: 10.3390/jcm13164695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Objectives: We aimed to evaluate and compare the diagnostic capacity of five cognitive screening tests for the diagnosis of mild cognitive impairment (MCI) in patients consulting by memory loss. Methods: A cross-sectional study involving 140 participants with a mean age of 74.42 ± 7.60 years, 87 (62.14%) women. Patients were classified as MCI or cognitively unimpaired according to a comprehensive neuropsychological battery. The diagnostic properties of the following screening tests were compared: Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination III (ACE-III) and Mini-Addenbrooke (M-ACE), Memory Impairment Screen (MIS), Montreal Cognitive Assessment (MoCA), and Rowland Universal Dementia Assessment Scale (RUDAS). Results: The area under the curve (AUC) was 0.861 for the ACE-III, 0.867 for M-ACE, 0.791 for MoCA, 0.795 for MMSE, 0.731 for RUDAS, and 0.672 for MIS. For the memory components, the AUC was 0.869 for ACE-III, 0.717 for MMSE, 0.755 for MoCA, and 0.720 for RUDAS. Cronbach's alpha was 0.827 for ACE-III, 0.505 for MMSE, 0.896 for MoCA, and 0.721 for RUDAS. Correlations with Free and Cued Selective Reminding Test were moderate with M-ACE, ACE-III, and MoCA, and moderate for the other tests. The M-ACE showed the best balance between diagnostic capacity and time of administration. Conclusions: ACE-III and its brief version M-ACE showed better diagnostic properties for the diagnosis of MCI than the other screening tests. MoCA and MMSE showed adequate properties, while the diagnostic capacity of MIS and RUDAS was limited.
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Affiliation(s)
- María Valles-Salgado
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Jordi A. Matias-Guiu
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Alfonso Delgado-Álvarez
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
- Department of Psychobiology & Behavioral Sciences Methods, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Cristina Delgado-Alonso
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - María José Gil-Moreno
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Esther Valiente-Gordillo
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Juan Ignacio López-Carbonero
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Lucía Fernández-Romero
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Lidia Peña-DeDiego
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Silvia Oliver-Mas
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Jorge Matías-Guiu
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
| | - Maria Diez-Cirarda
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.V.-S.); (J.A.M.-G.); (J.M.-G.)
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Alzola P, Carnero C, Bermejo-Pareja F, Sánchez-Benavides G, Peña-Casanova J, Puertas-Martín V, Fernández-Calvo B, Contador I. Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights. J Clin Med 2024; 13:3442. [PMID: 38929971 PMCID: PMC11204334 DOI: 10.3390/jcm13123442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Dementia remains an underdiagnosed syndrome, and there is a need to improve the early detection of cognitive decline. This narrative review examines the role of neuropsychological assessment in the characterization of cognitive changes associated with dementia syndrome at different states. The first section describes the early indicators of cognitive decline and the major barriers to their identification. Further, the optimal cognitive screening conditions and the most widely accepted tests are described. The second section analyzes the main differences in cognitive performance between Alzheimer's disease and other subtypes of dementia. Finally, the current challenges of neuropsychological assessment in aging/dementia and future approaches are discussed. Essentially, we find that current research is beginning to uncover early cognitive changes that precede dementia, while continuing to improve and refine the differential diagnosis of neurodegenerative disorders that cause dementia. However, neuropsychology faces several barriers, including the cultural diversity of the populations, a limited implementation in public health systems, and the adaptation to technological advances. Nowadays, neuropsychological assessment plays a fundamental role in characterizing cognitive decline in the different stages of dementia, but more efforts are needed to develop harmonized procedures that facilitate its use in different clinical contexts and research protocols.
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Affiliation(s)
- Patricia Alzola
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
| | - Cristóbal Carnero
- Neurology Department, Granada University Hospital Complex, 18014 Granada, Spain
| | - Félix Bermejo-Pareja
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Institute of Health Carlos III, 28029 Madrid, Spain
- Institute of Research i+12, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | | | | | | | | | - Israel Contador
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain;
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Tainta M, Ecay-Torres M, de Arriba M, Barandiaran M, Otaegui-Arrazola A, Iriondo A, Garcia-Sebastian M, Estanga A, Saldias J, Clerigue M, Gabilondo A, Ros N, Mugica J, Barandiaran A, Mangialasche F, Kivipelto M, Arrospide A, Mar J, Martinez-Lage P. GOIZ ZAINDU study: a FINGER-like multidomain lifestyle intervention feasibility randomized trial to prevent dementia in Southern Europe. Alzheimers Res Ther 2024; 16:44. [PMID: 38413990 PMCID: PMC10898038 DOI: 10.1186/s13195-024-01393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND GOIZ ZAINDU ("caring early" in Basque) is a pilot study to adapt the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) methodology to the Basque population and evaluate the feasibility and adherence to a FINGER-like multidomain intervention program. Additional aims included the assessment of efficacy on cognition and data collection to design a large efficacy trial. METHOD GOIZ ZAINDU is a 1-year, randomized, controlled trial of a multidomain intervention in persons aged 60+ years, with Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score ≥ 6, no diagnosis of dementia, and below-than-expected performance in at least one of three cognitive screening tests. Randomization to a multidomain intervention (MD-Int) or regular health advice (RHA) was stratified by sex, age (>/≤ 75), and cognitive status (mild cognitive impairment (MCI)/normal cognition). MD-Int included cardiovascular risk factor control, nutritional counseling, physical activity, and cognitive training. The primary outcomes were retention rate and adherence to the intervention program. Exploratory cognitive outcomes included changes in the Neuropsychological Test Battery z-scores. Analyses were performed according to the intention to treat. RESULTS One hundred twenty-five participants were recruited (mean age: 75.64 (± 6.46); 58% women). The MD-Int (n = 61) and RHA (n = 64) groups were balanced in terms of their demographics and cognition. Fifty-two (85%) participants from the RHA group and 56 (88%) from the MD-Int group completed the study. More than 70% of the participants had high overall adherence to the intervention activities. The risk of cognitive decline was higher in the RHA group than in the MD-Int group in terms of executive function (p =.019) and processing speed scores (p =.026). CONCLUSIONS The GOIZ-ZAINDU study proved that the FINGER methodology is adaptable and feasible in a different socio-cultural environment. The exploratory efficacy results showed a lower risk of decline in executive function and processing speed in the intervention group. These results support the design of a large-scale efficacy trial. TRIAL REGISTRATION GOIZ ZAINDU feasibility trial was approved and registered by the Euskadi Drug Research Ethics Committee (ID: PI2017134) on 23 January 2018. Retrospectively registered in ClinicalTrials.gov (NCT06163716) on 8 December 2023.
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Affiliation(s)
- Mikel Tainta
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | | | - Maria de Arriba
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | - Myriam Barandiaran
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | | | - Ane Iriondo
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | | | - Ainara Estanga
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | - Jon Saldias
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | | | - Alazne Gabilondo
- Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, País Vasco, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI) Bidasoa, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | - Naia Ros
- University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Justo Mugica
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, País Vasco, Spain
| | - Aitziber Barandiaran
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, País Vasco, Spain
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Arantzazu Arrospide
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | - Javier Mar
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
- Instituto de Investigación en Servicios Sanitarios Kronikgune, Barakaldo, Spain
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Rapin A, Calmus A, Pradeau C, Taiar R, Belassian G, Godefroy O, Carazo-Mendez S, Boyer FC. Effect of oxygen therapy duration on cognitive impairment 12 months after hospitalization for SARS-COV-2 infection. J Rehabil Med 2023; 55:jrm12609. [PMID: 37974332 DOI: 10.2340/jrm.v55.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/08/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To identify predictors of persistent cognitive impairment at 12 months after hospitalization due to COVID-19 (SARS-CoV-2) infection. DESIGN Retrospective, single-centre study. SUBJECTS All consecutive patients assessed in physical and rehabilitation medicine consultations at 3 months with a neuropsychiatric testing (NPT) at 6 months. METHODS A Mini Mental State Examination (MMSE) was performed at 3 months and NPT at 6 and 12 months, exploring global cognitive efficiency, attention and processing speed, short-term memory and executive function. Logistic regression and receiver operating characteristic curves were used to identify predictors of persistent cognitive impairment. RESULTS Among 56 patients, 64.3% and 53.6% had 1 or more impaired cognitive functions at 6 and 12 months, respectively, attention and processing speed being the most represented (41.1% at 12 month). Duration of oxygen therapy (odds ratio 0.926 [0.871-0.985], p = 0.015) and MMSE score at 3 months (odds ratio 0.464 [0.276-0.783], p = 0.004) were associated with cognitive impairment at 12 months by multivariable analysis (R² 0.372-0.497). CONCLUSIONS Half of patients have cognitive impairment 12 months after acute SARS-CoV-2 infection requiring hospitalization. The duration of oxygen therapy in acute care could be a protective parameter. Systematic evaluation with the MMSE at 3 months after infection might be an effective tool to detect risk.
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Affiliation(s)
- Amandine Rapin
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France; Faculty of Medicine, Reims Champagne-Ardenne University, MATIM, Reims, France VieFra, EA3797, Reims, France.
| | - Arnaud Calmus
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France; Reims Champagne-Ardenne University, C2S, EA6291, Reims, France
| | - Charles Pradeau
- Physical and Rehabilitation Medicine department, Strasbourg University Hospital, Strasbourg, France
| | - Redha Taiar
- Reims Champagne-Ardenne University, MATIM, Reims, France
| | - Gaël Belassian
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France
| | - Olivier Godefroy
- Functional neuroscience and pathologies laboratory (UR UPJV 4559), Amiens University Hospital , Amiens, France
| | - Sandy Carazo-Mendez
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France
| | - Francois C Boyer
- Department of Physical and Rehabilitation Medicine, hôpital Sebastopol, Reims, France; Faculty of Medicine, Reims Champagne-Ardenne University, MATIM, Reims, France VieFra, EA3797, Reims, France
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Carnero-Pardo C, López-Alcalde S, Florido-Santiago M, Espinosa-García M, Rego-García I, Calle-Calle R, Carrera-Muñoz I, de la Vega-Cotarelo R. Diagnostic accuracy and predictive validity of combined use of Fototest and Mini-Cog in cognitive impairment. Neurologia 2023; 38:653-662. [PMID: 37858894 DOI: 10.1016/j.nrleng.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/28/2021] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. METHODS We performed a phase III diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. RESULTS The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs 233.9 s [45.2]; P < .0001). CONCLUSIONS Combined application of the Fototest and Mini-Cog takes less than 4 minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy.
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Affiliation(s)
| | | | | | | | - I Rego-García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - R Calle-Calle
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - I Carrera-Muñoz
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Fakoury MK, Schmidt SL, Brandão Mello CE, Filho ADC, Amendola Pires MM. Cognitive Performance in Asymptomatic Elderly People with Hepatitis C: The Role of Education. J Clin Med 2023; 12:4588. [PMID: 37510703 PMCID: PMC10380825 DOI: 10.3390/jcm12144588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Neurotropism of the hepatitis C virus (HCV) can be the source of subtle neuropsychological symptoms in non-cirrhotic patients. Age is a risk factor for cognitive impairment (CI). Thus, asymptomatic elderly people who carry HCV might be at a greater risk of CI. Education can influence test performance. OBJECTIVES (1) To verify whether elderly people with HCV performed poorer than controls on cognitive tests. (2) To analyze how education affects performance. (3) To verify whether the extent of the effect of education on performance depends on the group (HCV vs. controls) and the type of cognitive test. METHODS Asymptomatic HCV carriers older than 60 years (n = 41) were matched with 41 corresponding controls. All participants performed the following tests: Mini-Cog, Mini Mental State Examination, clock drawing test (CDT), and verbal fluency. RESULTS (1) There were no significant differences in cognitive performance between the two groups. (2) Higher education was always associated with better performance. (3) There was a significant group difference in the slopes of the regression lines between years of education and CDT performance. No differences were found for the other three tests. CONCLUSION Considering the scores on the CDT, the rate of improvement in performance when schooling increases is higher in HCV carriers.
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Affiliation(s)
- Max Kopti Fakoury
- Department of Internal Medicine, Gaffrée and Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
- Graduate Program in Neurology, Department of Neurology, PPGNEURO-UNIRIO, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
- Laboratory of Behavioral Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
- RENASCER Multidisciplinary Program of the Third Age, Gaffrée and Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
| | - Sergio Luis Schmidt
- Graduate Program in Neurology, Department of Neurology, PPGNEURO-UNIRIO, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
- Laboratory of Behavioral Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
- RENASCER Multidisciplinary Program of the Third Age, Gaffrée and Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
| | - Carlos Eduardo Brandão Mello
- Department of Internal Medicine, Gaffrée and Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
- Graduate Program in Neurology, Department of Neurology, PPGNEURO-UNIRIO, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
- Graduate Program in HIV/AIDS Infection and Viral Hepatitis, PPGHIV/HV-UNIRIO, School of Medicine and Surgery, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
| | - Aureo do Carmo Filho
- Graduate Program in Neurology, Department of Neurology, PPGNEURO-UNIRIO, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
- Laboratory of Behavioral Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
| | - Marcia Maria Amendola Pires
- Graduate Program in Neurology, Department of Neurology, PPGNEURO-UNIRIO, Federal University of the State of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
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Perez-Valero E, Gutierrez CAM, Lopez-Gordo MA, Alcalde SL. Evaluating the feasibility of cognitive impairment detection in Alzheimer's disease screening using a computerized visual dynamic test. J Neuroeng Rehabil 2023; 20:43. [PMID: 37046310 PMCID: PMC10091634 DOI: 10.1186/s12984-023-01155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative disease without known cure. However, early medical treatment can help control its progression and postpone intellectual decay. Since AD is preceded by a period of cognitive deterioration, the effective assessment of cognitive capabilities is crucial to develop reliable screening procedures. For this purpose, cognitive tests are extensively used to evaluate cognitive areas such as language, attention, or memory. METHODS In this work, we analyzed the potential of a visual dynamics evaluation, the rapid serial visual presentation task (RSVP), for the detection of cognitive impairment in AD. We compared this evaluation with two of the most extended brief cognitive tests applied in Spain: the Clock-drawing test (CDT) and the Phototest. For this purpose, we assessed a group of patients (mild AD and mild cognitive impairment) and controls, and we evaluated the ability of the three tests for the discrimination of the two groups. RESULTS The preliminary results obtained suggest the RSVP performance is statistically higher for the controls than for the patients (p-value = 0.013). Furthermore, we obtained promising classification results for this test (mean accuracy of 0.91 with 95% confidence interval 0.72, 0.97). CONCLUSIONS Since the RSVP is a computerized, auto-scored, and potentially self-administered brief test, it could contribute to speeding-up cognitive impairment screening and to reducing the associated costs. Furthermore, this evaluation could be combined with other tests to augment the efficiency of cognitive impairment screening protocols and to potentially monitor patients under medical treatment.
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Affiliation(s)
- Eduardo Perez-Valero
- Department of Computer Engineering, Automation and Robotics, University of Granada, Granada, Spain
- Brain-Computer Interfaces Laboratory, Research Centre for Information and Communications Technologies, Granada, Spain
| | - Christian A Morillas Gutierrez
- Department of Computer Engineering, Automation and Robotics, University of Granada, Granada, Spain
- Brain-Computer Interfaces Laboratory, Research Centre for Information and Communications Technologies, Granada, Spain
| | - Miguel Angel Lopez-Gordo
- Department of Signal Theory, Telematics, and Communications, University of Granada, Granada, Spain.
- Brain-Computer Interfaces Laboratory, Research Centre for Information and Communications Technologies, Granada, Spain.
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Design and Verbal Fluency in Alzheimer's Disease and Frontotemporal Dementia: Clinical and Metabolic Correlates. J Int Neuropsychol Soc 2022; 28:947-962. [PMID: 34569460 DOI: 10.1017/s1355617721001144] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cognitive processes underlying verbal and design fluency, and their neural correlates in patients with Alzheimer's disease (AD) and behavioural variant Frontotemporal Dementia (bvFTD) remain unclear. We hypothesised that verbal and design fluency may be associated with distinct neuropsychological processes in AD and FTD, showing different patterns of impairment and neural basis. METHODS We enrolled 142 participants including patients with AD (n = 80, mean age = 74.71), bvFTD (n = 34, mean age = 68.18), and healthy controls (HCs) (n = 28, mean age = 71.14), that underwent cognitive assessment and 18F-fluorodeoxyglucose positron emission tomography imaging. RESULTS Semantic and phonemic fluency showed the largest effect sizes between groups, showing lower scores in bvFTD than AD and HCs, and lower scores in AD than HC. Both AD and bvFTD showed a lower number of unique designs in design fluency in comparison to HC. Semantic fluency was correlated with left frontotemporal lobe in AD, and with left frontal, caudate, and thalamus in bvFTD. Percentage of unique designs in design fluency was associated with the metabolism of the bilateral fronto-temporo-parietal cortex in AD, and the bilateral frontal cortex with right predominance in bvFTD. Repetitions in AD were correlated with bilateral frontal, temporal, and parietal lobes, and with left prefrontal cortex in bvFTD. CONCLUSIONS Our findings demonstrate differential underlying cognitive processes in verbal and design fluency in AD and bvFTD. While memory and executive functioning associated with fronto-temporo-parietal regions were key in AD, attention and executive functions correlated with the frontal cortex and played a more significant role in bvFTD during fluency tasks.
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Tainta M, Iriondo A, Ecay-Torres M, Estanga A, de Arriba M, Barandiaran M, Clerigue M, Garcia-Sebastian M, Villanua J, Izagirre A, Saldias J, Aramburu A, Taboada J, Múgica J, Barandiaran A, Arrospide A, Mar J, Martinez-Lage P. Brief cognitive tests as a decision-making tool in primary care. A population and validation study. Neurologia 2022:S2173-5808(22)00082-7. [PMID: 35963538 DOI: 10.1016/j.nrleng.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Brief cognitive tests (BCT) are used in primary care (PC) for the detection of cognitive impairment (CI). Still, there are little data on their diagnostic utility (DU) in a community setting. This work evaluates the DU at the population level of Fototest, T@M, AD8 questionnaire and MMSE. It provides new cut-off points (CoP) validated in a CI early detection program. MATERIAL AND METHODS In the population and validation samples, the evaluation was carried out in two phases, a first of screening and administration of BCT and a second of clinical diagnosis, blinded to the results of the BCT, applying the current NIA-AA criteria. The DU of BCT in the population sample was evaluated with the area under the ROC curve (aROC). Youden index and the CoP with the best specificity that ensured a sensitivity of 80% were used to decide on the most appropriate CoP. The sensitivity, specificity, and predictive values for these CoP were calculated in the validation sample. RESULTS 260 participants (23.1% with CI) from the population sample and 177 (42.4% with CI) from the validation sample were included. The Fototest has the best UD at the population level (aROC 0.851), which improves with the combination of Fototest and AD8 (aROC 0.875). The proposed CoP are AD8 ≥ 1, Fototest ≤ 35, T@M ≤ 40, and MMSE ≤ 26. CONCLUSION BCT are helpful in detecting CI in PC. This work supports the use of more demanding PoC.
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Affiliation(s)
- M Tainta
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain; Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain.
| | - A Iriondo
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M Ecay-Torres
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - A Estanga
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M de Arriba
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M Barandiaran
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain; Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M Clerigue
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | | | - J Villanua
- Osatek SA, Hospital Donostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - A Izagirre
- Universidad del País Vasco (UPV-EHU), Facultad de Medicina y Enfermería, Donostia-San Sebastián, Guipúzcoa, Spain
| | - J Saldias
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - A Aramburu
- Osakidetza, Organización Sanitaria Integrada (OSI) Debabarrena, Spain
| | - J Taboada
- Osakidetza, Organización Sanitaria Integrada (OSI) Bilbao Basurto, Spain
| | - J Múgica
- Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, Spain
| | - A Barandiaran
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, Spain
| | - A Arrospide
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - J Mar
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain; Instituto de Investigación en Servicios Sanitarios Kronikgune, Barakaldo, Vizcaya, Spain
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10
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Tainta M, Iriondo A, Ecay-Torres M, Estanga A, de Arriba M, Barandiaran M, Clerigue M, Garcia-Sebastian M, Villanua J, Izagirre A, Saldias J, Aramburu A, Taboada J, Múgica J, Barandiaran A, Arrospide A, Mar J, Martinez-Lage P. Test cognitivos breves como herramienta de decisión en Atención Primaria. Estudio poblacional y de validación. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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11
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Carnero-Pardo C, Rego-García I, Mené Llorente M, Alonso Ródenas M, Vílchez Carrillo R. Diagnostic performance of brief cognitive tests in cognitive impairment screening. Neurologia 2022; 37:441-449. [PMID: 31402066 DOI: 10.1016/j.nrl.2019.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES This study aims to assess and compare the diagnostic performance of brief cognitive tests for cognitive impairment (CI) screening recommended by the Spanish guidelines for the integral care of people with Alzheimer's disease and other dementias. MATERIAL AND METHODS We performed a phase iii study into the accuracy of diagnostic tests, including patients with suspected CI in a primary care setting. All patients completed the Mini-Mental State Examination (MMSE), the Mini Examen Cognoscitivo (MEC), the Short Portable Mental Status Questionnaire (SPMSQ), the Memory Impairment Screen (MIS), the Clock Drawing Test (CDT), the Eurotest, the Fototest, and the Memory Alteration Test (M@T). CI was diagnosed independently by researchers blinded to scores on these tests. Diagnostic performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC). RESULTS The study included 141 individuals (86 with CI). The Eurotest and M@T (AUC ± SE: 0.91 ± 0.02 and 0.90 ± 0.02, respectively) took longer to administer (mean [SD]: 7.1 [1.8] and 6.8 [2.2] min, respectively) and have significantly better diagnostic performance compared to the MMSE, MEC, SPMSQ, and CDT, but not compared to MIS or Fototest (both with an AUC of 0.87 ± 0.03), with the latter taking less than half as long to administer (2.8 [0.8] min). The M@T and MIS only evaluate memory, and the latter cannot be administered to illiterate people. CONCLUSION The most advisable tests for CI screening in primary care are the Eurotest, M@T, and Fototest, with the latter being the most efficient as it takes half as long to administer.
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Affiliation(s)
| | - I Rego-García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | | | | | - R Vílchez Carrillo
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
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12
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Caldichoury N, Soto-Añari M, Camargo L, Porto MF, Herrera-Pino J, Shelach S, Rivera-Fernández C, Ramos-Henderson M, Gargiulo PA, López N. Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults. Dement Neuropsychol 2022; 16:316-323. [PMID: 36619838 PMCID: PMC9762386 DOI: 10.1590/1980-5764-dn-2021-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 01/11/2023] Open
Abstract
The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.
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Affiliation(s)
- Nicole Caldichoury
- Universidad de Los Lagos, Departamento de Ciencias Sociales, Osorno,
Chile
| | - Marcio Soto-Añari
- Universidad Católica San Pablo, Laboratorio de Neurociencia,
Arequipa, Perú
| | - Loida Camargo
- Universidad del Sinú, Facultad de Medicina, Cartagena de Indias,
Colombia
| | - María Fernanda Porto
- Universidad de la Costa, Departamento de Ciencias Sociales,
Barranquilla, Colombia
| | | | - Salomón Shelach
- Universidad Católica San Pablo, Laboratorio de Neurociencia,
Arequipa, Perú
| | | | - Miguel Ramos-Henderson
- Universidad Santo Tomás, Facultad De Salud, Centro de Investigación
e Innovación en Gerontología Aplicada, Antofagasta, Chile
| | - Pascual Angel Gargiulo
- Universidad Nacional de Cuyo, Facultad de Ciencias Médicas,
Departamento de Patología, Laboratorio de Neurociencias y Psicología Experimental,
Mendoza, Argentina
| | - Norman López
- Universidad de la Costa, Departamento de Ciencias Sociales,
Barranquilla, Colombia
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13
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Lin S, Chen M. Gender-specific impact of cognitive impairment on all-cause mortality in older persons: A meta-analysis. Exp Gerontol 2022; 165:111860. [DOI: 10.1016/j.exger.2022.111860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/23/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
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14
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Diagnostic performance of brief cognitive tests in cognitive impairment screening. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:441-449. [DOI: 10.1016/j.nrleng.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/06/2019] [Indexed: 11/19/2022] Open
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15
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Soares JZ, Valeur J, Šaltytė Benth J, Knapskog AB, Selbæk G, Arefi G, Gilfillan DG, Tollisen A, Bogdanovic N, Pettersen R. Vitamin D in Alzheimer's Disease: Low Levels in Cerebrospinal Fluid Despite Normal Amounts in Serum. J Alzheimers Dis 2022; 86:1301-1314. [PMID: 35180126 DOI: 10.3233/jad-215536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vitamin D insufficiency has been suggested as a dementia risk factor. OBJECTIVE In this cross-sectional, explorative study we investigated whether levels of vitamin D in cerebrospinal fluid (CSF) are lower in patients with positive biomarkers of Alzheimer's disease (AD) compared to cognitively healthy controls and whether polymorphisms of the vitamin D receptor (VDR) gene, FokI, BsmI, ApaI, and TaqI, are associated with levels of vitamin D in CSF and cognition. METHODS We included 100 patients≥65 years assessed for cognitive impairment and 76 cognitively healthy controls. Levels of 25-hydroxyvitamin D (25(OH)D) in both serum and CSF, and VDR polymorphisms were analyzed. RESULTS The mean level of 25(OH)D in serum was 78.6 (SD 28.9) nmol/l. While serum levels of 25(OH)D were not significantly different between the groups, CSF levels of 25(OH)D were significantly lower in patients with positive AD core biomarkers (p = 0.001) compared to patients without such biomarkers. Individuals with the BsmI major homozygote genotype had significantly lower results on a 10-word delayed recall test (p = 0.044) and verbal fluency test (p = 0.013), and individuals with the TaqI major homozygote genotype had significantly lower results on a verbal fluency test (p = 0.030) compared to individuals with the corresponding minor homozygote genotype. CONCLUSION Patients with positive AD core biomarkers have low CSF levels of 25(OH)D, despite sufficient serum levels. CSF levels of 25(OH)D do not seem to be affected by any of the four VDR gene polymorphisms. TaqI and BsmI major homozygote genotypes might be at increased risk for development of cognitive decline.
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Affiliation(s)
- Jelena Zugic Soares
- Medical Department, Section of Geriatrics, Lovisenberg Diaconal Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway.,Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Jørgen Valeur
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | | | - Geir Selbæk
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Golchin Arefi
- Department of Medical Genetics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - D Gregor Gilfillan
- Department of Medical Genetics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Anita Tollisen
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Nenad Bogdanovic
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department for Neurobiology, Caring Science and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Renate Pettersen
- Medical Department, Section of Geriatrics, Lovisenberg Diaconal Hospital, Oslo, Norway
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16
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Carnero Pardo C, Carrera Muñoz I, Triguero Cueva L, López Alcalde S, Vílchez Carrillo R. Normative data for the Fototest from neurological patients with no cognitive impairment. Neurologia 2022; 37:45-52. [PMID: 29853272 DOI: 10.1016/j.nrl.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/01/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). MATERIAL AND METHODS We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). RESULTS We included a sample of 1,055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ± 5.3; P10: 28; P5: 27) and naming (5,9±0,3; 6; 5), free recall (8.5 ± 2.2; 6; 4), total recall (10.0 ± 1.5; 8; 7), and naming fluency scores (18.7 ± 4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ± 0.3 (ß ± SE) for sex (female), -2.4 ± 0.3 for age (> 65), and -1.6 ± 0.4 and 3.3 ± 0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). CONCLUSION We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting.
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Affiliation(s)
- C Carnero Pardo
- Unidad de Neurología Cognitivo-Conductual, Servicio de Neurología, Complejo Hospitalario Universitario de Granada, Granada, España; FIDYAN Neurocenter, Granada, España.
| | - I Carrera Muñoz
- Unidad de Neurología Cognitivo-Conductual, Servicio de Neurología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - L Triguero Cueva
- Unidad de Neurología Cognitivo-Conductual, Servicio de Neurología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - S López Alcalde
- Unidad de Neurología Cognitivo-Conductual, Servicio de Neurología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - R Vílchez Carrillo
- Unidad de Neurología Cognitivo-Conductual, Servicio de Neurología, Complejo Hospitalario Universitario de Granada, Granada, España
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17
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Normative data for the Fototest from neurological patients with no cognitive impairment. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:45-52. [DOI: 10.1016/j.nrleng.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/01/2018] [Indexed: 11/17/2022] Open
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18
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Carnero-Pardo C, Rego-García I, Barrios-López JM, Blanco-Madera S, Calle-Calle R, López-Alcalde S, Vílchez-Carrillo RM. Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment. Neurologia 2022; 37:13-20. [PMID: 30850258 DOI: 10.1016/j.nrl.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI). METHODS We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point. RESULTS The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC±sensitivity: 0.88±0.01 vs 0.84±0.01; P<.01). Both instruments were less useful for screening in individuals with a low education level (0.74±0.05 vs 0.75±0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95%CI, 0.87-0.93) and a specificity of 0.71 (95%CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95%CI, 0.72-0.81) and a specificity of 0.80 (95%CI, 0.75-0.85). CONCLUSION In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education.
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Affiliation(s)
| | - I Rego-García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - J M Barrios-López
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - S Blanco-Madera
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - R Calle-Calle
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | | | - R M Vílchez-Carrillo
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
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19
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Tang Y, Yuan X, Duan J, Zhang X, Chen J, Zhou Y, Song F, Zhou D. White Matter Characteristics of Cognitive Impairment in Tap-Test Positive Idiopathic Normal Pressure Hydrocephalus: A Diffusion Tensor Tract-Based Spatial Study. Front Neurosci 2021; 15:774638. [PMID: 34924943 PMCID: PMC8678068 DOI: 10.3389/fnins.2021.774638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
The present study was designed to systemically evaluate changes in the diffusion tensor imaging (DTI)-derived parameters of iNPH (idiopathic normal pressure hydrocephalus) patients with different responses to the tap test (TT), and to correlate cognitive impairment with white matter (WM) degeneration. This study included 22 iNPH patients and 14 healthy controls with structural magnetic resonance imaging (MRI) and DTI scanning. DTI was used to explore the differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) for all participants. DTI parameters were evaluated using an ROI (region of interest)-based and tract-based spatial statistics (TBSS) approach. Neuropsychological assessments and the idiopathic normal pressure hydrocephalus grading scoring scale (iNPHGS) were performed. Compared to the TT non-responders, the TT responders group had significantly lower FA values in the corpus callosum, cingulum cingulate gyrus, superior longitudinal fasciculus, and lower AD values in the right cingulum cingulate gyrus and the left posterior thalamic radiation. Besides, the MD values were significantly increased in the corpus callosum, left anterior corona radiata, and the RD values in the corpus callosum and cingulum cingulate gyrus. In addition, the cognitive improvement was negatively correlated with FA of the corpus callosum, cingulum cingulate gyrus, and MD values of the genu of corpus callosum. While, the cognitive improvement was positively related to the AD of the cingulum cingulate gyrus, superior longitudinal, and RD values of the corpus callosum, cingulum cingulate gyrus and uncinate fasciculus. The ROI specific WM lesions in iNPH patients are the underlying basis for cognitive impairment.
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Affiliation(s)
- Yufeng Tang
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xiaoqin Yuan
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Jinfeng Duan
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xianwen Zhang
- Department of Neurology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Jiao Chen
- Department of Radiology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Ying Zhou
- Department of Radiology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Fangzhou Song
- Basic Medicine College, Chongqing Medical University, Chongqing, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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20
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Pellicer-Espinosa I, Díaz-Orueta U. Cognitive Screening Instruments for Older Adults with Low Educational and Literacy Levels: A Systematic Review. J Appl Gerontol 2021; 41:1222-1231. [PMID: 34856843 PMCID: PMC8966106 DOI: 10.1177/07334648211056230] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study presents a systematic review on existing cognitive screening tools for mild cognitive impairment and dementia in populations with low education and literacy levels. Cochrane Library, PubMed and LILACS databases were examined for studies including adults aged 50 years old or older with low educational level. 61 articles were included. Despite its frequent use, studies on Mini-Mental State Examination (MMSE) revealed that educational level biased the score obtained, regardless of other factors. Separately, the Informant Questionnaire on Cognitive Decline in the Elderly, the Fototest, or the Eurotest, appear to minimize the effect of education and literacy. MMSE is unreliable for individuals with low literacy. Tasks involving reading, writing, arithmetics, drawing, praxis, visuospatial, and visuoconstructive skills have a greater educational bias than naming, orientation, or memory. An adequate determination of educational level and validation of instruments in populations with heterogeneous levels of literacy requires further research.
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Affiliation(s)
| | - Unai Díaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, Ireland
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21
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Graeff DB, Lui JM, Zucco NDP, Alves ALS, Forcelini CM, Dalmolin BM. Clock drawing test: comparison between the Pfizer and the Shulman systems. Dement Neuropsychol 2021; 15:480-484. [PMID: 35509798 PMCID: PMC9018089 DOI: 10.1590/1980-57642021dn15-040009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Cognitive decline can be screened by the clock drawing test (CDT), which has several versions. Objective: This survey aimed to analyze the correlation between two simple methods for scoring the CDT. Methods: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects’ CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman’s rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores. Results: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001). Conclusions: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.
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García-Manzanares MD, Sánchez-Pérez A, Alfaro-Sáez A, Limiñana-Gras RM, Sunyer-Catllà M, López-Roig S. Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:748-756. [PMID: 34649818 DOI: 10.1016/j.nrleng.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/04/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S). METHODS The linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years. RESULTS The OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems. CONCLUSION The OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke.
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Affiliation(s)
- M D García-Manzanares
- Departamento de Patología y Cirugía, Universidad Miguel Hernández de Elche, Alicante, Spain; Servicio de Rehabilitación, Hospital Clínico Universitario de San Juan, Alicante, Spain
| | - A Sánchez-Pérez
- Departamento de Patología y Cirugía, Universidad Miguel Hernández de Elche, Alicante, Spain.
| | - A Alfaro-Sáez
- Sección de Neurología, Hospital de la Vega Baja de Orihuela, Alicante, Spain; CIBER-BBN, Grupo de Neuroingeniería Biomédica, Universidad Miguel Hernández de Elche, Alicante, Spain
| | - R M Limiñana-Gras
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Facultad de Psicología, Universidad de Murcia, Murcia, Spain
| | - M Sunyer-Catllà
- Servicio de Rehabilitación, Hospital Clínico Universitario de San Juan, Alicante, Spain
| | - S López-Roig
- Departamento de Ciencias del Comportamiento y Salud, Unidad de Psicología, Universidad Miguel Hernández de Elche, Alicante, Spain
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Carnero-Pardo C, Rego-García I, Barrios-López JM, Blanco-Madera S, Calle-Calle R, López-Alcalde S, Vílchez-Carrillo RM. Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:13-20. [PMID: 34538774 DOI: 10.1016/j.nrleng.2018.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 12/22/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI). METHODS We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point. RESULTS The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC ± sensitivity: 0.88 ± 0.01 vs 0.84 ± 0.01; P < .01). Both instruments were less useful for screening in individuals with a low education level (0.74 ± 0.05 vs 0.75 ± 0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95% CI, 0.87-0.93) and a specificity of 0.71 (95% CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95% CI, 0.72-0.81) and a specificity of 0.80 (95% CI, 0.75-0.85). CONCLUSION In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education.
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Affiliation(s)
| | - I Rego-García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J M Barrios-López
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - S Blanco-Madera
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - R Calle-Calle
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - R M Vílchez-Carrillo
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Lopez-Gutierrez L, García-Alberca JM, Mendoza S, Gris E, De la Guía MP, Marin-Carmona JM, Alarcón-Martín E, Lobato A, Cruz-Gamero JM, Cura L, Ocejo O, Torrecilla J, Nieto MD, Urbano C, Pareja N, Luque M, García-Peralta M, Carrillejo R, Royo JL. The Genetic Research in Alzheimer Disease (GERALD) Initiative Finds rs9320913 as a Neural eQTL of lincRNA AL589740.1. Int J Alzheimers Dis 2021; 2021:3064224. [PMID: 34557314 PMCID: PMC8455222 DOI: 10.1155/2021/3064224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/13/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
Alzheimer's disease is the most common cause of dementia worldwide, and longitudinal studies are crucial to find the factors affecting disease development. Here, we describe a novel initiative from southern Spain designed to contribute in the identification of the genetic component of the cognitive decline of Alzheimer's disease patients. The germline variant rs9320913 is a C>A substitution mapping within a gene desert. Although it has been previously associated to a higher educational achievement and increased fluid intelligence, its role on Alzheimer's disease risk and progression remains elusive. A total of 407 subjects were included in the study, comprising 153 Alzheimer disease patients and 254 healthy controls. We have explored the rs9320913 contribution to both Alzheimer disease risk and progression according to the Mini-Mental State Exams. We found that rs9320913 maps within a central nervous system lincRNA AL589740.1. eQTL results show that rs9320913 correlated with the brain-frontal cortex (beta = -0.15, p value = 0.057) and brain-spinal cord (beta of -0.23, p value = 0.037). We did not find rs9320913 to be associated to AD risk, although AA patients seemed to exhibit a less pronounced Mini-Mental State Exam score decline.
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Affiliation(s)
- Lidia Lopez-Gutierrez
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología, Facultad de Medicina, Universidad de Málaga, Blv. Luis Pasteur s/n. 29071 Málaga, Spain
| | | | - Silvia Mendoza
- Instituto Andaluz de Neurociencia (IANEC), Calle Álamos, 17, 29012 Málaga, Spain
| | - Esther Gris
- Instituto Andaluz de Neurociencia (IANEC), Calle Álamos, 17, 29012 Málaga, Spain
| | - María Paz De la Guía
- Instituto Andaluz de Neurociencia (IANEC), Calle Álamos, 17, 29012 Málaga, Spain
| | - José Manuel Marin-Carmona
- Asociación de Familiares de Personas con Alzheimer, Málaga, Camino de los Almendrales, 35, 29013 Málaga, Spain
| | - Emilio Alarcón-Martín
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología, Facultad de Medicina, Universidad de Málaga, Blv. Luis Pasteur s/n. 29071 Málaga, Spain
| | - Almudena Lobato
- Asociación de Familiares de Personas con Alzheimer, Málaga, Camino de los Almendrales, 35, 29013 Málaga, Spain
| | - Jose Manuel Cruz-Gamero
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología, Facultad de Medicina, Universidad de Málaga, Blv. Luis Pasteur s/n. 29071 Málaga, Spain
| | - Laura Cura
- Asociación de Familiares de Personas con Alzheimer, Málaga, Camino de los Almendrales, 35, 29013 Málaga, Spain
| | - Olga Ocejo
- Centro Residencial Almudena, Calle Galicia, 3, 29730 Rincón de la Victoria, Spain
| | - Javier Torrecilla
- Centro Residencial Almudena, Calle Galicia, 3, 29730 Rincón de la Victoria, Spain
| | - María Dolores Nieto
- Hospital Hermanas Hospitalarias del Sagrado Corazón, Calle San Juan Bosco, 41, 29014 Málaga, Spain
| | - Concepción Urbano
- Hospital Hermanas Hospitalarias del Sagrado Corazón, Calle San Juan Bosco, 41, 29014 Málaga, Spain
| | - Nuria Pareja
- Asociación de Familiares de Enfermos de Alzheimer de la Axarquía, Calle Francisco Labao Gámez, 29700 Vélez-Málaga, Spain
| | - Macarena Luque
- Centro Residencial Élite, Calle Picos de Europa, 23, 29018 Málaga, Spain
| | | | - Rosario Carrillejo
- Asociación Criptana de Enfermos de Alzheimer, Calle Álvarez de Castro, s/n. 13610 Campo de Criptana, Spain
| | - José Luis Royo
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología, Facultad de Medicina, Universidad de Málaga, Blv. Luis Pasteur s/n. 29071 Málaga, Spain
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Paz EV, Puga C, Ekonen C, Pintos P, Trossero I, Richards A, Lascombes I, De Vita S, Leist M, Corleto M, García Basalo MJ. Letter and category Fluency Test in Spanish-Speaking Children with Neurodevelopmental Disorders. Neurol India 2021; 69:102-106. [PMID: 33642279 DOI: 10.4103/0028-3886.310066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Verbal fluency test is a short psychometric test, which is sensitive to verbal ability and executive control impairment. We did not find studies that analyze verbal fluency in relation to the neurodevelopmental disorders in Spanish-speaking children with letters P-M. Our objective was to analyze the verbal fluency of Spanish-speaking children with neurodevelopmental disorders. Method We carried out a retrospective cross-sectional study to analyze the performance of children who had undergone a neuropsychological assessment. Results We included 164 patients. There were 55 (33.54%) patients with low intellectual performance (LIP), 19 (11.59%) patients with dyslexia , and 90 (54.88%) patients had an ADHD. Patients with LIP showed lower phonological fluency than patients with ADHD. As for semantic fluidity, differences were observed between patients with LIP and ADHD and also between LIP and dyslexia. The probability of having LIP was 9.6 times greater when somebody had a scale score lower than 7 in the PF task and it was 16.7 times greater when the scale score was lower than 7 in the SF task. Conclusions There was a direct relationship between FSIQ and the performance in verbal fluency test, which is a brief and effective neuropsychological test in revealing deficits in executive functions, verbal abilities, and LIP.
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Affiliation(s)
- Esteban Vaucheret Paz
- Department of Child Neurology and Child Hospital Italiano de Buenos Aires, Argentina
| | - Celeste Puga
- Department of Child Neurology and Child Hospital Italiano de Buenos Aires, Argentina
| | - Christy Ekonen
- Department of Neuropsychology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Paula Pintos
- Department of Neuropsychology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Isabel Trossero
- Department of Neuropsychology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Ana Richards
- Department of Neuropsychology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Isabel Lascombes
- Department of Neuropsychology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Soledad De Vita
- Department of Neuropsychology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Mariana Leist
- Department of Child Neurology and Child Hospital Italiano de Buenos Aires, Argentina
| | - Mariela Corleto
- Department of Neuropsychology Section, Hospital Italiano de Buenos Aires, Argentina
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Carnero-Pardo C, López-Alcalde S, Florido-Santiago M, Espinosa-García M, Rego-García I, Calle-Calle R, Carrera-Muñoz I, de la Vega-Cotarelo R. Diagnostic accuracy and predictive validity of associated use of Fototest and Mini-Cog in cognitive impairment. Neurologia 2021; 38:S0213-4853(21)00052-9. [PMID: 33896655 DOI: 10.1016/j.nrl.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/20/2021] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. METHODS We performed a phase iii diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs. consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. RESULTS The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs. 233.9 s [45.2]; P<.0001). CONCLUSIONS Combined application of the Fototest and Mini-Cog takes less than 4minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy.
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Affiliation(s)
| | | | | | | | - I Rego-García
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - R Calle-Calle
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - I Carrera-Muñoz
- Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España
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Lu L, Chen L, Wu W, Wang Y, Liu Z, Xu J, Yang Q, Zhao J, Liu L, Yu H. Consistency and applicability of different brief screen instrument of cognitive function in elderly population. BMC Neurol 2021; 21:95. [PMID: 33648444 PMCID: PMC7919302 DOI: 10.1186/s12883-021-02048-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening for cognitive impairment (CI) is often hampered by lack of consensus as to which screening instrument to use. The aim is to assess the consistence and applicability of different CI screening tools. METHOD In a cross-sectional study from October 2017 to September 2018 in 7 communities in Shanghai, China, elder (≧60) residential volunteers with no history of major cardiovascular diseases, cancers and other comorbidities known to affect cognitive functions were recruited. The participants underwent tests with 7 cognitive function screening instruments. Multivariate linear regressions were performed to test correlations between demographic characteristics, including gender, age, education, and marital status, with cognitive test scores. Mini-Mental State Examination (MMSE) score adjusted according to the correlation coefficients was used to detect CI with a cutoff of 24. Other cognitive function scores were compared between participants with and without CI. In addition, Pearson's correlation test was used to detect association between different test scores. RESULTS 172 participants with relatively low education levels were included. Age and education showed significant association with cognitive test scores. Using adjusted MMSE, 39.6% of participants were identified with CI, while the percentage was 87.2% when adjusted Montreal Cognitive Assessment (MoCA) with cutoff of 26 was used. Analysis of "abnormal" test scores showed that MMSE had the highest percentage of valid data (98.8%). MoCA and Isaacs test of Verbal Fluency (VF) score had correlation with most the other scores, while MMSE only significantly associated with VF and MoCA. CONCLUSIONS MMSE may still present the most applicable tools for quick screen of cognitive functions, especially when environmental conditions may interfere with participants' attention.
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Affiliation(s)
- Lixia Lu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Lin Chen
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Weiwen Wu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China.
| | - Yang Wang
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Zhenbao Liu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Jun Xu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Qianhong Yang
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Jun Zhao
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Liangxian Liu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
| | - Hui Yu
- Department of Neurology, Qingpu Branch of Zhongshan Hospital, Fudan University, 1158 East of Park Road, Qingpu District, Shanghai, 201700, China
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Gómez CS, Rodríguez EJF. The effectiveness of a training programme in everyday cognition in healthy older adults: a randomised controlled trial. BMC Geriatr 2021; 21:79. [PMID: 33509113 PMCID: PMC7842078 DOI: 10.1186/s12877-020-01998-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Everyday cognition is the application of basic cognitive skills and knowledge of the specific cognitive domain for the resolution of problems that are integrated within the instrumental domains of functioning. The main objective is to evaluate the effectiveness of a Training Programme in Everyday Cognition in order to improve the levels of everyday cognition and global cognitive performance in older adults. METHODS A randomised controlled trial of two groups. The sample was composed of healthy older adults. The intervention of the experimental group consisted of an Everyday Cognition Training Programme, and the intervention of the control group consisted of a Conventional Cognitive Training Programme. The Rapid Assessment of Cognitive Functions test (ERFC) and the Everyday Cognition Battery test (ECB) were used to assess the intervention. RESULTS Total sample (n = 237) composed of 44 men and 223 women, with a mean age of 73.45 years. Statistically significant differences (p < 0.001) were evidenced between the control group and the experimental group in both the ECB and ERFC; in the final evaluation of the study and in the follow-up. CONCLUSION The use of a Daily Cognition Training Programme presents greater benefits in terms of both global cognitive performance and everyday cognition than the use of a Conventional Cognitive Training Programme in elderly adults. TRIAL REGISTRATION ClinicalTrials.gov : NCT04041999 . Retrospectively registered. Date of trial registration: 8th July 2019.
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Affiliation(s)
- Celia Sánchez Gómez
- Department of Evolutionary and Educational Psychologyt, Faculty of Psychology. University of Salamanca, Avenida de la Merced, 109, 37005 Salamanca, Spain
| | - Eduardo José Fernández Rodríguez
- Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca, Salamanca, Spain
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Sagiadinou M, Plerou A. Brief Cognitive Tests in the Case of Dementia and Alzheimer's Disease Early Diagnosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1195:127-135. [PMID: 32468467 DOI: 10.1007/978-3-030-32633-3_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nowadays, Alzheimer's disease (AD) diagnosis is considered to be a crucial and extremely complex process. Nevertheless, psychometric tools, like Mini-Mental State Evaluation (MMSE), are used to address cognitive function assessment and clinical evaluation processes. However, MMSE's sensitivity in the diagnosis of mild cognitive impairment is debatable in terms of education, age, or nationality. Typical psychometric tools with the use of "paper and pencil" methods combined with physiology measurements are proposed in order to enhance validity and effectiveness in the case of Alzheimer's disease cognitive deficits. The objective of this review study is to highlight the effectiveness of brief cognitive tests (BCT) in the case of dementia and Alzheimer's disease screening. Authors' future work will focus on the application of BCT in MCI diagnosis and evaluation.
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Affiliation(s)
| | - Antonia Plerou
- Department of Informatics, Ionian University, Corfu, Greece
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30
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García-Manzanares MD, Sánchez-Pérez A, Alfaro-Sáez A, Limiñana-Gras RM, Sunyer-Catllà M, López-Roig S. Cultural and linguistic adaptation of the Oxford Cognitive Screen to the Spanish population. Neurologia 2020; 37:S0213-4853(19)30147-1. [PMID: 31980284 DOI: 10.1016/j.nrl.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/30/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Stroke is the sixth leading cause of disability in Spain. Patients may present motor, sensory, or cognitive sequelae, which can be minimised with early treatment. To this end, there is a need for quick-to-administer assessment tools to evaluate deficits in these areas. The Oxford Cognitive Screen (OCS) is a brief test specifically designed to assess cognitive function in patients with stroke. Our aim in this study is to report the linguistic and cultural adaptation of a Spanish-language version of the test (OCS-S). MATERIAL AND METHODS The linguistic validation was conducted with a process of double translation and 10 consensus meetings of the multidisciplinary research team. We also performed 3 pilot studies, with 5 potential users, 23 healthy individuals, and 23 patients with stroke (ischaemic in 61% of cases and haemorrhagic in 39%), respectively; participants were aged between 31 and 88 years. RESULTS The OCS-S includes the 10 subtests, the coding of responses, and the scoring system from the original version. We modified and extended the instructions for administration in order to ensure the reliability of the content and its application. Five tasks were modified (images, numbers, and sentences) and the praxis subtest was modified to evaluate both hands. The pilot studies confirmed comprehension in the target population, independently of any cognitive problems. CONCLUSIONS The OCS-S is conceptually and linguistically equivalent to the original test, enabling psychometric assessment and application of the test in the Spanish population. The OCS-S may be a useful screening tool for quickly assessing cognitive function after stroke.
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Affiliation(s)
- M D García-Manzanares
- Departamento de Patología y Cirugía, Universidad Miguel Hernández de Elche, Alicante, España; Servicio de Rehabilitación, Hospital Clínico Universitario de San Juan, Alicante, España
| | - A Sánchez-Pérez
- Departamento de Patología y Cirugía, Universidad Miguel Hernández de Elche, Alicante, España.
| | - A Alfaro-Sáez
- Sección de Neurología, Hospital de la Vega Baja de Orihuela, Alicante. España; CIBER-BBN, Grupo de Neuroingeniería Biomédica, Universidad Miguel Hernández de Elche, Alicante. España
| | - R M Limiñana-Gras
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Facultad de Psicología, Universidad de Murcia, Murcia, España
| | - M Sunyer-Catllà
- Servicio de Rehabilitación, Hospital Clínico Universitario de San Juan, Alicante, España
| | - S López-Roig
- Departamento de Ciencias del Comportamiento y Salud, Unidad de Psicología, Universidad Miguel Hernández de Elche, Alicante, España
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Zugic Soares J, Pettersen R, Saltyte Benth J, Knapskog AB, Selbæk G, Bogdanovic N. Higher Vitamin D Levels Are Associated with Better Attentional Functions: Data from the NorCog Register. J Nutr Health Aging 2019; 23:725-731. [PMID: 31560030 DOI: 10.1007/s12603-019-1220-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this cross-sectional study was to evaluate which cognitive domains are mostly affected in persons with vitamin D insufficiency or deficiency, defined as 25(OH)D < 50 nmol/l and < 25 nmol/l, respectively. METHODS Data were collected from the Norwegian register for persons assessed for cognitive symptoms (NorCog). 580 persons aged ≥ 65 years were included. The following cognitive and neuropsychiatric tests were used: Mini Mental State Examination, Norwegian Revised Version (MMSE-NR), the Clock Drawing test, the Trail Making Test A and B, the 10-word memory test and the figure copying test from CERAD - immediate and delayed recall, The Controlled Oral Word Association Test -FAS and Boston Naming test. Neuropsychiatric symptoms were assessed by Neuropsychiatric Inventory-Questionnaire and Cornell Scale for Depression in Dementia. RESULTS Vitamin D-insufficiency was found in approx. 30 % of the study cohort. After adjustment for relevant covariates, higher serum 25(OH)D levels were associated with higher score on MMSE-NR (p=0.032) and 10-word Memory Test, immediate recall (p=0.038), as well as faster execution of Trail Making Test A and B (p=0.038 and p=0.021, respectively). Other tests were not significantly associated with 25(OH)D levels. CONCLUSION Higher vitamin D levels appear to be associated with better cognition, especially in areas of executive function and mental flexibility.
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Affiliation(s)
- J Zugic Soares
- J. Zugic Soares, Medical Department, Section of Geriatrics, Lovisenberg Diaconal Hospital, PB 4970 Nydalen 0440 Oslo, Norway,
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Vega Alonso T, Miralles Espí M, Mangas Reina J, Castrillejo Pérez D, Rivas Pérez A, Gil Costa M, López Maside A, Arrieta Antón E, Lozano Alonso J, Fragua Gil M. Prevalence of cognitive impairment in Spain: The Gómez de Caso study in health sentinel networks. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Matías-Guiu JA, Valles-Salgado M, Rognoni T, Hamre-Gil F, Moreno-Ramos T, Matías-Guiu J. Comparative Diagnostic Accuracy of the ACE-III, MIS, MMSE, MoCA, and RUDAS for Screening of Alzheimer Disease. Dement Geriatr Cogn Disord 2018; 43:237-246. [PMID: 28384640 DOI: 10.1159/000469658] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Our aim was to evaluate and compare the diagnostic properties of 5 screening tests for the diagnosis of mild Alzheimer disease (AD). METHODS We conducted a prospective and cross-sectional study of 92 patients with mild AD and of 68 healthy controls from our Department of Neurology. The diagnostic properties of the following tests were compared: Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination III (ACE-III), Memory Impairment Screen (MIS), Montreal Cognitive Assessment (MoCA), and Rowland Universal Dementia Assessment Scale (RUDAS). RESULTS All tests yielded high diagnostic accuracy, with the ACE-III achieving the best diagnostic properties. The area under the curve was 0.897 for the ACE-III, 0.889 for the RUDAS, 0.874 for the MMSE, 0.866 for the MIS, and 0.856 for the MoCA. The Mini-ACE score from the ACE-III showed the highest diagnostic capacity (area under the curve 0.939). Memory scores of the ACE-III and of the RUDAS showed a better diagnostic accuracy than those of the MMSE and of the MoCA. All tests, especially the ACE-III, conveyed a higher diagnostic accuracy in patients with full primary education than in the less educated group. Implementing normative data improved the diagnostic accuracy of the ACE-III but not that of the other tests. CONCLUSIONS The ACE-III achieved the highest diagnostic accuracy. This better discrimination was more evident in the more educated group.
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Affiliation(s)
- Jordi A Matías-Guiu
- Department of Neurology, San Carlos Institute for Health Research (IdISSC), Universidad Complutense, Madrid, Spain
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García Cabrera AM, Jiménez Rodríguez RM, Reyes Díaz ML, Vázquez Monchul JM, Fernández MR, Díaz Pavón JM, González CP, Padillo Ruiz FJ, de la Portilla de Juan F. Fecal Incontinence in Older Patients. A Narrative Review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.cireng.2017.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Incontinencia fecal en el paciente anciano. Revisión de conjunto. Cir Esp 2018; 96:131-137. [DOI: 10.1016/j.ciresp.2017.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 11/10/2017] [Accepted: 12/06/2017] [Indexed: 12/29/2022]
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Prevalence of cognitive impairment in Spain: The Gómez de Caso study in health sentinel networks. Neurologia 2016; 33:491-498. [PMID: 27939116 DOI: 10.1016/j.nrl.2016.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/03/2016] [Accepted: 10/13/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Cognitive impairment, a clinical entity causing complete or partial intellectual dysfunction, is a major public health concern that poses a challenge for health and social services. The purpose of this study is to estimate the prevalence of this disorder in people aged 65 and older visiting the primary care physician in 5 health sentinel networks. METHOD A sample of patients visiting their primary care doctor on 4 randomly selected days completed the Mini-Cog screening test. Diagnosis of cognitive impairment was confirmed with the Mini-Mental State Examination and the Alzheimer's Questionnaire. We estimated raw and adjusted rates using demographic and social variables. RESULTS We included 4,624 patients from 5 autonomous communities and representing a population of 1,723,216 inhabitants. The adjusted prevalence rate was 18.5% (95% CI 17.3-19.7], with differences between sentinel networks. Women showed higher adjusted rates than men: 18.5 vs. 14.3%. The highest prevalence rate was observed in people aged 85 and older (45.3%); prevalence rates vary depending on education level and marital status. CONCLUSIONS Cognitive impairment is a frequent reason for consultations in primary care. Its prevalence is higher in women and increases exponentially with age. A number of sensitive, validated tools have been proven useful in screening for and confirming cognitive impairment. Using these tools in primary care settings enables early treatment of these patients.
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