Spanish normative studies (NEURONORMA-Plus project): norms for the Wisconsin Card Sorting Test, the Modified Taylor Complex Figure, and the Ruff-Light Trail Learning Test

OBJECTIVE

The present study aims to provide norms and age-, education-, and sex-adjusted data for the Wisconsin Card Sorting Test (WCST), the Modified Taylor Complex Figure (MTCF), and the Ruff-Light Trail Learning Test (RULIT) as part of the NEURONORMA-Plus project.

METHODS

We recruited 308 cognitively healthy individuals aged between 18 and 92 years. Tables are provided to convert raw scores to age-adjusted scaled scores, as well as adjustments for education and sex after applying independent regression models in 2 age groups (< 50 and ≥ 50 years).

RESULTS

Older age had a negative effect on performance in both age groups. We observed a positive effect of education on WCST performance in the younger group (< 50 years), and on all MTCF measures (with the exception of the recognition task) in the older group (≥ 50 years). Education had no impact on performance in the RULIT, although sex did, with a small but significant effect whereby young men showed higher performance for one variable.

CONCLUSION

The normative data provided can contribute to the clinical interpretation of performance in these tests in the Spanish population.

Spanish normative studies (NEURONORMA-Plus project): norms for the Delis Kaplan-Design Fluency Test, Color Trails Test, and Dual Task

INTRODUCTION

Complex attention and non-verbal fluency tasks are used in neuropsychological assessments with the aim of exploring subdomains of executive function. The purpose of this study is to provide norms and age-, education-, and sex-adjusted data for the Delis Kaplan-Design Fluency Test (DK-DFT), Color Trails Test (CTT), and Dual Task (DT) as part of the NEURONORMA-Plus project.

METHODS

The sample included 308 cognitively unimpaired individuals aged between 18 and 92 years. Raw scores were converted to age-adjusted scaled scores. These were further converted into education- and sex-adjusted scaled scores by applying linear regression, with 2 age groups (< 50 and ≥ 50 years).

RESULTS

Overall, age had a negative impact on DK-DFT and CTT performance. We observed a positive effect of education on DK-DFT scores only in the older group (≥ 50 years). Moreover, younger men performed slightly better in the basic condition of this test. Education was positively associated with all CTT scores in both age groups, with the exception of the CTT-1 subtest in the younger group. Age and education did not influence DT performance, whereas sex did, with young women performing slightly better.

CONCLUSIONS

These normative data may be useful in the interpretation of neuropsychological assessments in the Spanish population.

Assessment of aphasia: dialectal and cultural considerations in neurology

INTRODUCTION

In the context of neurological disorders, language assessment is traditionally based on the use of the standard language of the community in which the assessment is performed. Dialectal variables constitute a 'forgotten' topic. This review aims to provide resources and working guidelines to overcome this limitation.

DEVELOPMENT

The study was conducted as follows: 1) review of basic concepts of dialectology (language, dialect, isogloss line, idiolect, register, 'standard variant', bilingualism); 2) characterisation of Spanish and Catalan dialectologies and search for online resources for the development of neurological assessment tools; 3) ad hoc search on the PubMed database (keywords 'dialect', 'aphasia' and 'multilingual').

CONCLUSIONS

We provide online resources to promote adequate development of assessment tools in Spanish and Catalan, accounting for Dialectal considerations. We propose a set of working guidelines for the introduction of Dialectal variables in language tests to ensure their ultimate objective: to evaluate the real use of the language, and not cultural knowledge of the standard language.

The CORCOBIA study: Cut-off points of Alzheimer's disease CSF biomarkers in a clinical cohort

INTRODUCTION

The analysis of the core biomarkers of Alzheimer's Disease (AD) in the cerebrospinal fluid (CSF) is recommended in the clinical units where it is available. Because of the absence of universal validated values, the determination of specific cut-off points for each center and its population is recommended. The main objective of the CORCOBIA study was to determine the cut-off points of core AD CSF biomarkers for several centers (Parc de Salut Mar, Barcelona and Hospital General de Granollers), which work with the same reference laboratory (Laboratori de Referència de Catalunya).

METHODS

Prospective study including cognitively unimpaired individuals (CU, n = 42), subjects with amnestic mild cognitive impairment (aMCI, n = 35) and patients with dementia due to Alzheimer's Disease (AD, n = 48), in whom clinical and neuropsychological assessment, neuroimaging, APOE genotyping and lumbar puncture to analyse amyloid beta peptides (Aβ42, Aβ40), total tau (tTau) and phosphorylated Tau (pTau181) using the Lumipulse G600II (Fujirebio) was performed. The values of sensitivity (SE), specificity (SP), predictive values and area under the curve (AUC) were calculated, determining the cut-off point according to the Youden index by comparing the CU and AD groups.

RESULTS

The resulting cut-offs and their AUC were the following: Aβ42 750 pg/mL (AUC 0.809); Aβ42/Aβ40 0.062 (AUC 0.78); pTau181 69.85 pg/mL (AUC 0.81); tTau 522.0 pg/mL (AUC 0.79); Aβ42/tTau 1.76 (AUC 0.86); Aβ42/pTau181 10.25 (AUC 0.86).

CONCLUSIONS

The determination of cut-off points of core AD CSF biomarkers for the participating centers allows a better diagnostic accuracy. The ratio CSF Aβ42/pTau181 shows the highest AUC and better balance between sensitivity and specificity.

Spanish normative studies (NEURONORMA-Plus project): norms for the Wisconsin Card Sorting Test, the Modified Taylor Complex Figure, and the Ruff-Light Trail Learning Test

OBJECTIVE

The present study aims to provide norms and age-, education-, and sex-adjusted data for the Wisconsin Card Sorting Test (WCST), the Modified Taylor Complex Figure (MTCF), and the Ruff-Light Trail Learning Test (RULIT) as part of the NEURONORMA-Plus project.

METHODS

We recruited 308 cognitively healthy individuals aged between 18 and 92 years. Tables are provided to convert raw scores to age-adjusted scaled scores, as well as adjustments for education and sex after applying independent regression models in 2 age groups (<50 and ≥50 years).

RESULTS

Older age had a negative effect on performance in both age groups. We observed a positive effect of education on WCST performance in the younger group (<50 years), and on all MTCF measures (with the exception of the recognition task) in the older group (≥50 years). Education had no impact on performance in the RULIT, although sex did, with a small but significant effect whereby young men showed higher performance for one variable.

CONCLUSION

The normative data provided can contribute to the clinical interpretation of performance in these tests in the Spanish population.

Spanish normative studies (NEURONORMA-Plus project): norms for the Delis Kaplan-Design Fluency Test, Color Trails Test, and Dual Task

INTRODUCTION

Complex attention and non-verbal fluency tasks are used in neuropsychological assessments with the aim of exploring subdomains of executive function. The purpose of this study is to provide norms and age-, education-, and sex-adjusted data for the Delis Kaplan-Design Fluency Test (DK-DFT), Color Trails Test (CTT), and Dual Task (DT) as part of the NEURONORMA-Plus project.

METHODS

The sample included 308 cognitively healthy individuals aged between 18 and 92 years. Raw scores were converted to age-adjusted scaled scores. These were further converted into education- and sex-adjusted scaled scores by applying linear regression, with 2 age groups (< 50 and ≥ 50 years).

RESULTS

Overall, age had a negative impact on DK-DFT and CTT performance. We observed a positive effect of education on DK-DFT scores only in the older group (≥ 50 years). Moreover, younger men performed slightly better in the basic condition of this test. Education was positively associated with all CTT scores in both age groups, with the exception of the CTT-1 subtest in the younger group. Age and education did not influence DT performance, whereas sex did, with young women performing slightly better.

CONCLUSIONS

These normative data may be useful in the interpretation of neuropsychological assessments in the Spanish population.

Development, equivalence study, and normative data of version B of the Spanish-language Free and Cued Selective Reminding Test

INTRODUCTION

The Free and Cued Selective Reminding Test (FCSRT) is widely used for the assessment of verbal episodic memory, mainly in patients with Alzheimer disease. A Spanish version of the FCSRT and normative data were developed within the NEURONORMA project. Availability of alternative, equivalent versions is useful for following patients up in clinical settings. This study aimed to develop an alternative version of the original FCSRT (version B) and to study its equivalence to the original Spanish test (version A), and its performance in a sample of healthy individuals, in order to develop reference data.

METHODS

We evaluated 232 healthy participants of the NEURONORMA-Plus project, aged between 18 and 90. Thirty-three participants were assessed with both versions using a counterbalanced design.

RESULTS

High intra-class correlation coefficients (between 0.8 and 0.9) were observed in the equivalence study. While no significant differences in performance were observed in total recall scores, free recall scores were significantly lower for version B.

CONCLUSIONS

These preliminary results suggest that the newly developed FCSRT version B is equivalent to version A in the main variables tested. Further studies are necessary to ensure interchangeability between versions. We provide normative data for the new version.

Diagnostic validity of the Alzheimer's disease functional assessment and change scale in mild cognitive impairment and mild to moderate Alzheimer's disease

BACKGROUND

The Alzheimer's Disease Functional Assessment and Change Scale (ADFACS) is a functional assessment instrument widely used in clinical research.

AIMS

To test the diagnostic and concurrent validity of the Spanish version of this scale and to describe the functional deficit pattern for mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia.

METHODS

The ADFACS, the Interview for Deterioration in Daily Living Activities in Dementia (IDDD), and the Mini Mental State Examination (MMSE) were administered to 146 control subjects (CS) and 165 patients (67 MCI and 98 AD). Nonparametric tests were used to compare the diagnostic groups. Cronbach's α and correlations with the MMSE and the IDDD were calculated. Sensitivity, specificity and predictive values were studied.

RESULTS

The ADFACS had a high internal consistency (α = 0.95). Three cutoff points of 1, 4, and 17 were provided to separate CS and MCI patients, MCI and mild AD patients, and mild AD and moderate AD patients, respectively. The ADFACS strongly correlated with functional (IDDD, 0.927) and cognitive (MMSE, 0.747) measures. A similar pattern of dysfunction, but in different grades, was found for the MCI and AD groups.

CONCLUSION

The ADFACS is a reliable, valid, and sensitive instrument to assess functional abilities; it is useful in dementia assessment for elderly populations.

Spanish normative studies in young adults (NEURONORMA young adults project): norms for Stroop Color-Word Interference and Tower of London-Drexel University tests

INTRODUCTION

The Stroop Color-Word Interference Test (Stroop) measures cognitive flexibility, selective attention, cognitive inhibition and information processing speed. The Tower of London-Drexel University version test (TOL) assesses higher-order problem solving and executive planning abilities.

OBJECTIVE

In this study, as part of the Spanish normative studies project in young adults (NEURONORMA young adults), we present normative data for the Stroop and young adults TOL tests.

MATERIAL AND METHODS

The sample consisted of 179 participants who are cognitively normal and range in age from 18 to 49 years. Tables are provided to convert raw scores to scaled scores. Scores adjusted for sociodemographic factors were obtained by applying linear regression techniques.

RESULTS

No effects were found for age and sex in either test. Educational level impacted most of the Stroop test variables and some of the TOL scores (Total Moves score and Total Initiation Time score).

CONCLUSIONS

The norms obtained will be extremely useful in the clinical evaluation of young Spanish adults.

Spanish version of the Bayer Activities of Daily Living scale in mild cognitive impairment and mild Alzheimer disease: discriminant and concurrent validity

AIMS

To test the discriminant and concurrent validity of the Spanish version of the Bayer Activities of Daily Living scale (B-ADL) in mild cognitive impairment (MCI) and mild Alzheimer disease (AD).

METHODS

The B-ADL scale, the Blessed Dementia Rating Scale (BDRS), and the Interview for Deterioration in Daily Living in Dementia (IDDD) were administered to 277 elderly Spanish patients (78 MCI and 199 AD). Correlations between scales were performed, and ROC curves were plotted.

RESULTS

In MCI and mild AD discrimination, an area under the ROC curve of 0.84 was found; a cut-off point of 3.3 was proposed with values of 0.81 for sensitivity and 0.72 for specificity. The B-ADL correlated positively to both the BDRS (r = 0.7) and the IDDD (r = 0.8).

CONCLUSION

The B-ADL is a valid and sensitive scale that can be used to discriminate mild AD from MCI.

Cognitive performance in recreational ecstasy polydrug users: a two-year follow-up study

There is important preclinical evidence of long lasting neurotoxic and selective effects of ecstasy MDMA on serotonin systems in non-human primates. In humans long-term recreational use of ecstasy has been mainly associated with learning and memory impairments. The aim of the present study was to investigate the neuropsychological profile associated with ecstasy use within recreational polydrug users, and describe the cognitive changes related to maintained or variable ecstasy use along a two years period. We administered cognitive measures of attention, executive functions, memory and learning to three groups of participants: 37 current polydrug users with regular consumption of ecstasy and cannabis, 23 current cannabis users and 34 non-users free of illicit drugs. Four cognitive assessments were conducted during two years. At baseline, ecstasy polydrug users showed significantly poorer performance than cannabis users and non-drug using controls in a measure of semantic word fluency. When ecstasy users were classified according to lifetime use of ecstasy, the more severe users (more than 100 tablets) showed additional deficits on episodic memory. After two years ecstasy users showed persistent deficits on verbal fluency, working memory and processing speed. These findings should be interpreted with caution, since the possibility of premorbid group differences cannot be entirely excluded. Our findings support that ecstasy use, or ecstasy/cannabis synergic effects, are responsible for the sub-clinical deficits observed in ecstasy polydrug users, and provides additional evidence for long-term cognitive impairment owing to ecstasy consumption in the context of polydrug use.

[Psychometry of dementias at debate]

The accurate diagnosis of dementias and the screening of cognitive impairment constitute a key to attend to the sociodemographical needs. This paper states the aims of screening and diagnosis, the tools used and their main psychometric features, especially, reliability and validity. The need to critically review the publications on this subject is highlighted and the Standards for Reporting of Diagnostic Accuracy (STARD) are mentioned. In addition, some proposals and recommendations from literature are cited and reviewed. Finally, the tests studied and used most by Spanish neurologists are commented on. The MMSE (Mini-Mental Status Examination), the MIS (Memory Impairment Screen) and the Eurotest stand out.

[Rapid Disability Rating Scale-2 in Alzheimer's disease: NORMACODEM project data]

INTRODUCTION

The study aimed to investigate the Rapid Disability Rating Scale-2 (RDRS-2) in Alzheimer's disease (AD). Test retest reliability, internal consistency, data of discriminant validity of the scale, correlations with other functional and cognitive measures were analyzed.

MATERIAL AND METHODS

451 subjects were assessed: 254 healthy controls, 86 with cognitive impairment but no dementia (CIND) and 111 subjects diagnosed of AD. Total and subscales scores of the RDRS-2 were obtained. The total score is the sum of three subscales: activities of daily living, disability, and special problems. To establish its correlation with other functional scales and cognitive instruments, the following tools were applied: Blessed Dementia Rating Scale (BDRS), Interview for the Deterioration of Daily Living in Dementia (IDDD), Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) and the Mini-Mental State Examination (MMSE).

STATISTICAL ANALYSIS

lineal multivariate regression analysis. Crossvalidation. ROC curves. Intraclass coefficient. Cronbach's alpha and Pearson's Correlation coefficient.

RESULTS

RDRS-2 scores by group were the following (mean and SD): Controls (18.95; 1.64), CIND (20.61; 2.88), and AD (28.96; 9.07). Results from regression analysis 282 demonstrated absence of influence of sociocultural variables such as age and education in RDRS-2 scores. Correlations with other instruments were as following: BDRS, r=0.820; IDDD, r=0.882; ADAS-Cog, r=0.762, and MMSE, r=0.742. Intraclass coefficient was 0.86 and Cronbach's alpha was 0.91. For the RDRS-2 the best cutoff score was 21 (82.88% sensitivity and 88.8% specificity). Area under the ROC curve was 0.92.

CONCLUSIONS

The Spanish adaptation of the RDRS-2 is free of sociocultural influence, and shows very adequate data on internal consistency and stability. Although not specifically designed for its use in AD it correlates highly and significantly with other functional scales as well as with the degree of cognitive impairment in AD.

[Test-retest and interrater reliability of Barcelona Test]

INTRODUCTION

The short version of the Barcelona Test is a clinical tool that covers a wide spectrum of neuropsychological skills. Since its creation in 1977, it has often been subject of study either for its internal aspects or in validation studies with other cognitive tests. The results indicate that the Barcelona Test is a useful instrument in detecting cognitive impairment.

METHOD

The aim of this study is to measure the testretest reliability and the interrater reliability of the Abbreviated Barcelona Test in normal population.

SAMPLE

the sample consists of 31 normal subjects (14 men and 17 women) from 20 to 65 years old.

INSTRUMENTS

Abbreviated Barcelona Test (TBA), Mini-Mental Status Examination (MMSE), Syndrome-Kurztest (SKT) and Interview for Deterioration of Daily living in Dementia (IDDD).

STATISTICAL ANALYSIS

descriptive statistics and intraclass correlation coefficient.

RESULTS

Test-retest reliability shows good intraclass correlation coefficients with both direct ICC=0.92 (IC 95%: 0.85-0.96) or typified scores ICC=0.79 (IC 95%: 0.61-0.89). Nevertheless, when each of the subtests is considered, correlations clearly show two characteristics: subtest with no or minimal range of scores and subtest with distribution of scores (as is the case of memory and executive function). The intraclass coefficient found for the interrater reliability is ICC =0.99 (IC 95 %: 0.99-0.99) and an alpha of 0.99 which indicate excellent reliability. As a whole, the abbreviated version of the Barcelona Test has excellent test-retest and interrater reliability psychometric characteristics.

[Spanish version of the Memory Impairment Screen (MIS): normative data and discriminant validity]

OBJECTIVE

Present data on discriminative and normative validity for the Memory Impairment Screen (MIS) in a cross-sectional validation study within a dementia-clinic setting using a Spanish adaptation of the MIS. Assess its usefulness as a screening instrument for memory problems related to primary dementing disorders, foremost Alzheimer's Disease (AD).

MATERIAL AND METHODS

403 subjects, including 188 demented subjects according to DSM-IV criteria (119 of which presented AD according to NINCDS-ADRDA criteria) and 215 controls, over 50 years. The MIS, a four word memory test using a specific encoding technique and scoring on a 0-8 range, formed part of the neuropsychological workup, but it was not used for diagnosis. Sensitivity, specificity and predictive values positive (PPV) and negative (NPV) were calculated for the MIS against the gold-standard of clinical diagnosis by two blinded clinicians. ROC curves for the discrimination between demented subjects and controls, and AD subjects and controls were plotted.

RESULTS

Control subjects were significantly younger and better educated than the demented samples (p<0.001). No sex differences could be established. ROC curves demonstrated excellent discriminative validity of the MIS 402 for dementia on a whole (0.944) and even better for AD (0.978). The MIS presents satisfying results regarding sensitivity and specificity as well as PPV for different base rates, but the most effective cut-off score lies at < or = 4 points. For all demented subjects this cut-off represents a sensitivity of 0.74 and specificity of 0.96; for AD results are 0.86 and 0.96. More importantly, PPV values are above 0.65 for assumed base rates of 10% and more. Negative predictive values are almost 1 for all assumed base rates.

CONCLUSION

The Spanish version of the MIS reliably differentiates between normal and demented subjects. Nevertheless one has to consider the setting of the study when interpreting the results. The use of the S-MIS seems to be justified as first level dementia screening tool.

[Diagnostic value and test-retest reliability of the Blessed Dementia Rating Scale for Alzheimer's disease: data from the NORMACODEM project]

INTRODUCTION

This study aims to discover the criterion validity of the Blessed Dementia Rating Scale (BDRS) for the diagnosis of Alzheimer's disease. Different cut-off scores and corresponding diagnostic sensitivities and specificities were established. Test-retest reliability and internal consistency of the BDRS were also analyzed.

METHODS

SAMPLE

451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with Alzheimer's disease).

INSTRUMENTS

scores from different sections of the Blessed score were obtained. The global score (BBRS-Total) is the result of the sum of the three sections, A (changes in every day activities), B (changes in habits) and C (changes in personality). The sum of parts A and B (BDRS-Mod) were also quantified.

STATISTICS

ROC curves, intraclass correlation coefficient and Cronbach's alpha.

RESULTS

The best cut-off score for the BDRS-Total was 3.5 (sensitivity: 87.39%, and specificity: 90%). For the BDRS-Mod, the best cut-off score was 1.5 (sensitivity: 90%, and specificity: 89%). Area under the ROC curve was 0.964 and 0.963 respectively. Intraclass correlation coefficient was 0.98 and Cronbach's alpha was 0.925.

CONCLUSIONS

The BDRS has good discriminative validity in terms of sensitivity, specificity and predictive value. It also has good test-retest reliability and internal consistency.

Influence of age, sex, and education on the Visual Object and Space Perception Battery (VOSP) in a healthy normal elderly population

The assessment of visual perception and cognition forms an important part of any general cognitive evaluation. We have studied the possible influence of age, sex, and education on a normal elderly Spanish population (90 healthy subjects) in performance in visual perception tasks. To evaluate visual perception and cognition, we have used the subjects performance with The Visual Object and Space Perception Battery (VOSP). The test consists of 8 subtests: 4 measure visual object perception (Incomplete Letters, Silhouettes, Object Decision, and Progressive Silhouettes) while the other 4 measure visual space perception (Dot Counting, Position Discrimination, Number Location, and Cube Analysis). The statistical procedures employed were either simple or multiple linear regression analyses (subtests with normal distribution) and Mann-Whitney tests, followed by ANOVA with Scheffe correction (subtests without normal distribution). Age and sex were found to be significant modifying factors in the Silhouettes, Object Decision, Progressive Silhouettes, Position Discrimination, and Cube Analysis subtests. Educational level was found to be a significant predictor of function for the Silhouettes and Object Decision subtests. The results of the sample were adjusted in line with the differences observed. Our study also offers preliminary normative data for the administration of the VOSP to an elderly Spanish population. The results are discussed and compared with similar studies performed in different cultural backgrounds.

[Correlations between cognition and function in Alzheimer's disease: based on the abbreviated Barcelona Test (a-BT)]

INTRODUCTION

The objective is to establish the existence of possible correlations between cognitive measures using the a-BT, and functional measures in a population of normal to moderately severe demented subjects.

METHODS

A sample of 107 subjects (42 healthy controls, 19 subjects with mild cognitive impairment and 46 patients with probable Alzheimer's disease) were included in the present study. The instruments of the cognitive measure used was the abbreviated Barcelona Test (a-BT), a test of general cognitive function. Apart from that, the following functional scales, evaluating activities of daily living, were used: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), and Interview for Deterioration in Daily living in Dementia (IDDD). The statistical procedures were the correlations between cognitive and functional measures using Pearson's correlation coefficient.

RESULTS

The correlations obtained between the cognitive and all functional measures were all highly significant (p < 0.0001) and consistently high, with correlations ranging between 0.72 and 0.80. Correlations between the a-BT and functional measures of more basic activities of daily living (RDRS-2, BDRS) were lower than those that included instrumental and some advanced activities of daily living (IDDD).

DISCUSSION

The present paper establishes the existence of satisfactory correlations between the functional measures studied and the global scores of the a-BT. These correlations are applicable for groups of subjects with cognitive impairment that does not reach the threshold of a diagnosis of dementia as well as subjects suffering from Alzheimer's disease, at least up to moderately severe cases. The global score of the a-BT allows for some degree of prediction of the functional status of a subject with suspected Alzheimer's disease pathology evaluated.

Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease

OBJECTIVE

To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease (AD) who are treated with a cholinesterase inhibitor (ChEI).

METHODS

Patients with mild cognitive impairment (MCI) (12), mild AD (48), and moderate AD (24) (Global Deterioration Scale stages 3, 4, and 5) were randomized to receive psychosocial support plus cognitive-motor intervention (experimental group) or psychosocial support alone (control group). Cognitive-motor intervention (CMI) consisted of a 1-year structured program of 103 sessions of cognitive exercises, plus social and psychomotor activities. The primary efficacy measure was the cognitive subscale of the AD Assessment Scale (ADAS-cog). Secondary efficacy measures were the Mini-Mental State Examination, the Functional Activities Questionnaire, and the Geriatric Depression Scale. Evaluations were conducted at 1, 3, 6, and 12 months by blinded evaluators.

RESULTS

Patients in the CMI group maintained cognitive status at month 6, whereas patients in the control group had significantly declined at that time. Cognitive response was higher in the patients with fewer years of formal education. In addition, more patients in the experimental group maintained or improved their affective status at month 12 (experimental group, 75%; control group, 47%; p = 0.017).

CONCLUSIONS

A long-term CMI in ChEI-treated early Alzheimer disease patients produced additional mood and cognitive benefits.

[Preliminary normative data for the second edition of the Boston Naming Test for young Spanish adults]

INTRODUCTION

The Boston Naming Test (BNT) is one of the most widely used tests in neuropsychological evaluation of language disorders, specifically when testing for anomia. The aim of this study is to establish preliminary normative data for the second edition of the BNT for young spanish adults (age range between 20 and 49 years).

METHODS

A total of 160 subjects (60 % female and 40 % male) were administered the BNT. Mean age was 33.89 years (SD: 9.45) and average number of years of education was 13.98 (SD: 3.97). The version used in the present study is the second edition of the BNT (Kaplan et al., 2001) which includes two new components: multiple choice and error typology.

STATISTICAL ANALYSIS

Descriptive statistics of the test's variables. Lineal regression to establish the possible degree of influence of the variables age and education on test performance.

RESULTS

The sample's mean score was 51.84. Education significantly influences the final score (B: 0.476; p= 0.001). Multiple choice was effective in 89 % of cases.

DISCUSSION

The present results will allow proper clinical interpretation of results in the BNT 2001 version in young Spanish adults.

Semantic verbal fluency of animals: a normative and predictive study in a Spanish population

Semantic verbal fluency is a very sensible but rather unspecific tool for the detection of neuropsychological deficits. This test is highly influenced by socio-cultural factors. Normative and predictive data for semantic verbal fluency of animals in a Spanish population are presented. The studied sample (n = 445) was stratified according to age and schooling. Statistical analysis reconfirmed a significant negative correlation (- 5.34) for age, and a significant positive correlation (5.34) for years of formal education. A predictive function for the production of names of animals during 1 min was established based on the subject's age and level of education: F(x) = 23.89 + age (- .144) + education (.39). The neuropsychological value and limitations of normative data and the predictive equation are discussed.

Adaptation and standardization of the geriatric evaluation of relative's rating instrument (GERRI) for Spain

BACKGROUND

The Geriatric Evaluation of Relative's Rating Instrument (GERRI) is a scale that evaluates the frequencies of alterations in behavior and functional capacity over a two-week period prior to exploration. The scale depends on the observations done by a relative o first caregiver of the studied subject.

AIM

To adapt and standardize the GERRI for the use in the Spanish population as a part of a general project to standardized cognitive and functional tests.

METHOD

The scale was administered to 444 subjects: 249 controls, 85 mild memory-cognitive disorders without dementia subjects (DWD) and 110 patients with Alzheimer-type dementia (ATD). An across-sectional statistical study was conducted in our samples stratified by age, gender and education. We evaluated the reliability of repeatability of the test, the internal reliability and the age, sex and education effects on the score of the different subscales. We also took into account the diagnostical validity in the Alzheimer disease and finally we correlated this test results with Mini mental test.

RESULTS

The demographic variables age and schooling were found to affect the GERRI subscales differently. Gender did not reach significance. Internal consistency for the GERRI-Social, -Mood and -Cognitive were 0.8620, 0.7647 and 0.9259, respectively.

CONCLUSION

The Spanish version of the GERRI may be applied to Spanish clinical series because of its reliable internal consistency and reproducibility.

[Catalan version of Barcelona Test's verbal subtests]

Test Barcelona. Bilingüismo catalán-castellano. Adaptación lingüística de instrumentos neuropsicológicos.

BACKGROUND AND OBJECTIVES

The present paper develops the Catalan version of the language subtests of the Barcelona Test (Peña-Casanova,1986) the original version of which was published in Spanish.

METHODS

To reach the Catalan version of the test it has been necessary to analyse the psycholinguistic variables of every item to then establish linguistically equivalent correlations.

RESULTS

There are some subtests for which no modifications have been needed. Nevertheless, and because of some psycholinguistic features of Catalan (Catalan's spelling is not completely free of ambiguity) some subtests have suffered substantial modifications. The following paper presents the justification of every modification based on the features of the Catalan language and also based on the original goals of the test. An appendix contains the final version of the Catalan adaptation for the language subtests of the Barcelona Test.

CONCLUSION

The present paper represents an advance in the assessment of neurological patients with language disfunctions. It will permit an appropiate assessment for the Spanish-Catalan bilingual patients.

[Proposal of criteria for clinical diagnosis of mild cognitive impairment, dementia and Alzheimer's disease]

The most widely accepted criteria for Alzheimer's disease (AD) diagnosis (NINCDS-ADRDA and DSM-IV) do not allow to differentiate accurately between AD and other degenerative dementias which have recently formulated criteria for its clinical diagnosis. Therefore, it is necessary to bring AD diagnostic criteria up to date in order to optimise their specificity, by assessing its most specific clinical manifestations, its most representative markers and those features typical of other diseases which are usually taken into account for a differential diagnosis. According to the latest reports on the subject, the disturbances suffered by memory, behaviour and the rest of cognitive and executive functions must be equally considered when establishing the syndromic diagnosis of dementia; this will always require the coexistence of an evident functional impairment. Due to this, the concepts of "dementia" and "mild cognitive impairment" should be clearly distinguished. For the time being, AD can only be diagnosed when dementia has been proved and this shows a series of cognitive, behavioural and neurological features which are representative of it. Nevertheless, some diagnostic markers appear to be precocious and specific enough to try to identify those patients who suffer from mild cognitive impairment due to an incipient stage of AD. We are suggesting some criteria for the clinical diagnosis of dementia, mild cognitive impairment and AD that seem to be more detail

Clinical validity of the 'mini-mental state' for Spanish speaking communities

The Mini-Mental State (MMS) is a brief structured test of cognitive function. The purpose of this study was to adapt and normalise MMS for the Spanish population. The test was administered to 450 subjects (253 control volunteers, 86 mild memory/cognitive impairment without dementia subjects - CIWD and 111 Alzheimer's Disease patients - AD). A cross-sectional statistical study in a population stratified by age and education was conducted. A more accurate diagnosis is provided by scores that have been adjusted for age and level of education. The recommended cut-off in our study was 24/25 (non-demented above 24). The adaptation and normalisation of MMS provides the Spanish population with a highly valuable screening tool.

The Bayer-Activities of Daily Living Scale (B-ADL): results from a validation study in three European countries

The Bayer-Activities of Daily Living Scale (B-ADL) is a 25-item, informant-rated questionnaire which was developed as a brief and internationally applicable instrument for assessing functional disabilities. The scale's target group are elderly patients suffering from mild to moderate dementia or cognitive impairment. To investigate the reliability and validity of different language versions, the B-ADL was administered in the UK, Germany, and Spain to a total of 1,433 subjects with a wide range of cognitive decline. The results from the three country samples were very similar, with internal consistency being above 0.98 (Cronbach alpha). A factor analysis revealed that a one-factor solution accounted for most of the variance. The B-ADL total score significantly increased between adjacent Global Deterioration Scale (GDS) stages 1 to 5. A second factor analysis entering additional variables (GDS stage, Mini-Mental State Examination or MMSE subscores, age, years of education, gender, and country) revealed that all B-ADL items loaded on the same factor, "dementia severity", and that they were not related to age, education, gender, or country. In the identification of subjects with clinically manifest dementia symptoms (GDS stages 4 and 5), the B-ADL proved to be as efficient as the MMSE in the UK and German samples and superior to the MMSE in the Spanish sample.

[Acquired dyslexias and dysgraphias under the prism of cognitive neuropsychology: a model for the Spanish language]

The present paper discusses the different clinical manifestations of acquired disorders of reading and writing from a neurocognitive viewpoint. Based on a specific functional architecture of reading and writing--a cognitive model; presented as well--the different syndromes of acquired dyslexias and dysgraphias, that have been described in the specialized literature during the last 25 years, will be reviewed. The different pathologies are distributed along three different functional axes: a plurimodal component, including the semantic system, for the description of peripheric disorders of reading and writing; a lexical block which is justified by the findings in patients with surface dyslexia/dysgraphia; and a third, sublexical component, in order to illustrate the different functional impairments in phonological dyslexia/dysgraphia. Following the description of syndromes due to selective "functional lesions", we discuss deep dyslexia/dysgraphia, a syndrome due to multiple functional lesions. All of the syndromes will be justified and discussed with respect to the different components of the functional architecture presented and are based on cases of the literature and personal observations. Concluding remarks will evaluate the new insights gained by the presented functional arquitecture in relation to other cognitive models for the analysis of reading aloud and writing to dictation of single words.

[Neuropsychological exploration in frontotemporal degeneration]

The present paper discusses the neuropsychological assessment in fronto-temporal lobe degeneration. Having established the neuroanatomical and functional basis for the discussion the major syndromes included in the concept of frontotemporal degeneration are reviewed from a neuropsychological standpoint. With reference to fronto-temporal dementia the different frontal or executive function tests and their limitations are discussed. With reference to progressive aphasia and semantic dementia we differentiate the distinct language profiles as observed in aphasia batteries and general neuropsychological tests. Reference is made to especially useful tests for the differentiation of the two syndromes from each other, as well as from other primary progressive disorders. Concluding remarks postulate a series of axis of cognitive function in fronto-temporal lobe degenerations, which exist at the functional as well as the anatomical level and along which the different syndromes evolve.

[Costs of health care resources of ambulatory-care patients diagnosed with Alzheimer's disease in Spain]

BACKGROUND

The annual consumption and costs of the health care resources used by ambulatory Alzheimer's disease patients were estimated. Patients were classified according to the degree of severity of the disease using Folstein's Mini Mental State Examination scale. The sociodemographic characteristics of both patients and their careers were described.

PATIENTS AND METHODS

Patients with an established diagnosis of Alzheimer's disease according to NINCDS/ADRDA criteria were included in the study. Information on the use of health and non-health care resources consumed during the last 12 months was recorded. The following scales were administered: MMSE, Global Deterioration Scale, Rapid Disability Rating Scale and Hachinski's scale modified by Rosen. Finally, the time dedicated by careers to look after the Alzheimer's disease patients was recorded.

RESULTS

A total of 337 patients were considered to be valid for the analysis with an average of 72 (8.4) years and with an average duration of the disease of 48.3 (35.7) months. The average annual cost per patient was 3,194,664 ptas. The average cost per patient in the group with MMSE > 18 was 2,119,889 ptas; 2,723,159 ptas. in those with MMSE 12-18 and 3,676,707 ptas. in the MMSE < 12 group.

CONCLUSIONS

In patients with Alzheimer's disease an increase in cost directly related to functional cognition state was observed. The most important cost component was that imputed to value time dedicated by principal career.

Clinical validity and utility of the interview for deterioration of daily living in dementia for Spanish-speaking communities NORMACODEM Group

The assessment of activities of daily living is a central procedure in the diagnosis of dementia. Few instruments in the field allow for early detection of functional decline because the items they use refer mainly to basic activities of daily living (BADL), which do not become compromised until later in the disease process. The Interview for Deterioration of Daily Living in Dementia (IDDD) may be a valuable tool for early detection of functional decline because it includes, apart from a BADL subscale, another subscale containing a variety of instrumental activities of daily living (LADL), which are the first to be affected in dementing processes. We present an adaptation and validation of the IDDD for Spanish-speaking communities (S-IDDD). A total of 254 control subjects (CONT), 86 patients with mild memory/cognitive impairment with no dementia (CIND), and 111 patients diagnosed with probable dementia of the Alzheimer type (DAT) participated in this project. IDDD total scores (mean and SD) were as follow: CONT: 33.1 (0.4); CIND: 35.2 (3.4); DAT: 54.3 (18.6). The present validation showed no sociodemographic effects on the IDDD total scores. The IDDD demonstrated great internal consistency (alpha = .985) and reproducibility (intraclass correlation coefficient = .94). Correlations were high (r = .81; p < .1) when they took into account the whole sample, but decreased significantly when the groups were separated by pathologic condition. The scale showed significant differences between DAT versus CIND and CONT. The IADL subscale differentiated all three groups, which makes it extremely valuable for early detection of functional decline. The present study shows that the S-IDDD is a reliable adaptation of the original IDDD scale and may be used successfully in Spanish populations for staging and follow-up of subjects with dementia.

[Constructive praxis to the copy: extended standards of the Barcelona test]

BACKGROUND

Drawings tasks have achieved a very central position in neurology by virtue of their sensitivity to many different kinds of brain lesions. Variables of age and education may significantly affect test performance and therefore should taken into account when developing test norms.

OBJECTIVES

To increase the sample of the original version of the Barcelona test (BT) and analyze the results of the drawing task.

PATIENTS AND METHODS

322 normal subjects (47.1% women and 52.9% males), stratified in 7 groups according to age and education were included in the large sample. Copying subtest of the BT were used. Descriptive statistics and multiple lineal regression were applied to the data.

RESULTS

Due to the relevance of age and education on coping drawing tasks (Kruskal-Wallis: p < 0.001 for age and p < 0.001 for education). Both variables (age and education) were analyzed using multiple lineal regression in order to establish possible effects of age and/or education for each group (F = 18.073; p < 0.001). Subjects aged more than 70 had the best adjust to the regression model (R2 = 0.4245; F = 18.07; p < 0.001; delta R2 = 13.56). Furthermore age has an important role as modulator to the results.

CONCLUSIONS

Age and education influenced copying drawing performance for raw scores as well as when considering timed performance, in a different way for each studied group. While the correlation of education and performance on copy drawing tasks is a direct one, for age this relation is inverse.

[Digit span, automatic speech and orientation: amplified norms of the Barcelona Test]

BACKGROUND

Digit span, automatic speech and orientation are screening tests of interest in neurology due to their high sensitivity in cerebral pathologies and easy applicability. These tasks assess attention, concentration, mental control, orientation and short-term memory.

OBJECTIVES

To analyze the impact of age and education on the results of the following subtest included in the Barcelona Test: digit span, automatic speech and orientation.

PATIENTS AND METHODS

275 normal subjects were evaluated. Mean (SD) age: 52 (17.7), range (18-19). Mean education: 9 (5.5) years, range (0-25). Subjects were stratified into 7 groups by age and education. Nine items of Barcelona Test were used: digits span forward and backward, automatic speech, forward and backward, with and without time, and person, time and place orientation.

RESULTS

Statistical description, parametric and non parametric test. The Kruskal Wallis test was used, showing that aged and education are significant difference in the automatic speech forward or backward, with or without time, while it did not showed a significant difference in the different groups in the orientation tests. Analysis of Variance for group of age and education showed significant differences in the digit span forward and backward (F = 19.92; p < 0.001; F = 18.44, p < 0.001), respectively.

CONCLUSIONS

Both age (inversely) and education (directly) influenced on the scores of the analyzed items, except to person, place and time orientation that are not affected for them.

[Abstract abilities: amplified norms for the Barcelona Test]

INTRODUCTION

By abstract abilities is understood the ability of comprehend relations identifying the essential components and taking out from them a common feature. Its evaluation constitutes a great challenge for neuropsychology. Several studies have showed the influence of age and formal education in the performance of tests assessing these abilities.

AIM

To analyse the WAIS-style abstract abilities included in the abbreviated version of the Barcelona Test determining the influence of and formal education and obtaining more normative data for a Spanish population.

METHOD

A sample of 264 subjects was randomly selected. The subtests of the Barcelona Test were administered in a single session to every subject. We selected the scores obtained in Arithmetic Problems (raw and timed), Similarities, Digit Symbol and Block Design (raw and timed).

RESULTS

The analysis of the variance showed statistically significant results of the selected items according to age and formal education. The formal education, as the lineal regression showed, resulted significant for all the items, being the Arithmetic Problems the only subtests not influenced significantly by the formal education.

CONCLUSION

The results obtained in this study are in general concordant to the ones of the reviewed bibliography.

Alzheimer's Disease Assessment Scale--cognitive in clinical practice

The goal of this article is (a) to review a series of measurement standards for group and individual-patient applications of cognitive tests for Alzheimer's disease (AD); and (b) to review the literature and to use specific data from the NORMACODEM (a project of standardization of cognitive and functional toosl for AD) to evaluate the measurement standards of the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog). Seven measurement standards for group and individual patient use were evaluated: practicality, extent of measurement, depth of measurement, cross-sectional precision, longitudinal precision, validity, and standardization. The results indicated that ADAS-Cog meets practicality standards, that the scoring method is not difficult, but training is needed to administer the test. In comparison with other rating scales, the ADAS-Cog is regarded as more comprehensive, although it is not a substitute for an extensive neuropsychological test. The ADAS-Cog is not a tool that is suitable for primary care physicians, although it is a valuable screening test that has utility in both early detection (diagnosis) and staging of AD, and is useful in the severity range of Global Dementia stages 1 to 6. Interrater reliability coefficients for the ADAS-Cog satisfy recommended standards, and the test shows good internal consistency and reproducibility. Age and education are associated with the ADAS-Cog score. There is, however, a lack of standardization, which restricts the comparability of study results, and test materials remain unpublished.

[Shortened version of the Barcelona test (III): criterion validity with the ADAS-Cog]

The aim of this study was to assess the criterion validity of a global score of an abbreviated version of the Barcelona Test (BTA), normalized for age and education, as a clinical neuropsychometric test for the assessment of cognitive impairment. This study made a correlational analysis between test scores of the BTA and scores of the cognitive part of the Alzheimer's Disease Assessment Scale (ADAS-Cog) adjusted for age and education. It was made in a University Hospital (Dementia Unit). A group of 172 subjects (74 male, 98 female) was distributed according the Global Deterioration Stages (GDS) from 1 to 6. GDS-1 (normal controls), n = 60; GDS-2 (subjective complaints), n = 27; GDS-3, n = 21, GDS-4, n = 22; GDS-5, n = 16; GDS 6, n = 26. All dementia patients fulfilled the NINCDS/ADRDA criteria. BTA global scores correlated significantly with adjusted scores on the ADAS-Cog (r = 0.872, r2 = 0.761), p < 0.0001. The BTA has a criterion validity as a clinical neuropsychometric test for the study of cognitive impairment.

[Shortened version of the Barcelona test (I): subtests and normal profiles]

The aim of this study was to define a shortened form of the Barcelona neuropsychological test to be used in clinical neurology. There was a selection of subtests from the original test and descriptive statistics of an enlarged number of normal volunteers. 341 normal subjects were studied, 178 male (52.19%) and 163 female (47.1%). Age mean: 54.80, SD = 17.44. Education: mean 9.0 years, SD: 5.4. Subjects were stratified in five groups considering age and education. Subtest were choose according clinical criteria and considering data from a previous study. Five different age and education scoring profiles were defined. This reduced version of the Barcelona test includes the main neuropsychological areas and it takes only 30-45 minutes administration. The Barcelona test meets practical standards in neuropsychology.

[Shortened version of the Barcelona test (II): global standard score]

The aim of this study was to determine a global scoring method for a shortened and version of the Barcelona Neuropsychological test (TB) of 55 items. 341 healthy volunteers, 178 male (52.19%), and 163 female (47.1%) were studied. Age mean: 54.80, SD = 17.44. Subjects were stratified in five groups considering age and education. A scale of cut-off points was selected in order to divide the scores of each subtest into three bands (categories): 0 (lowest), 1 (intermediate), 2 (highest). Raw scores (possible range 0-110) were obtained and then were converted to a mean of 100 and SD of 15 each normative group. Tables of normative data were obtained for each group. This study shows the cognitive profiles of the TB and a global standard score related to them. This global score will provide new possibilities in the neuropsychological assessment of neurological patients.

[Normalization of cognitive and functional assessment instruments for dementia (NORMACODEM) (I): objectives, content and population]

To adequately evaluate patients with 4 neuropsychological deficits a project for norming cognitive and functional instruments that assess dementia (NORMACODEM) was designed. Four hundred fifty-one subjects in three groups: 254 controls, 86 patients with minor memory/cognitive deficits without dementia (DWD) and 111 patients with probable Alzheimer-type dementia (ATD) according to the NINCDS/ADRDA criteria. Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale (ADAS), Abbreviated Barcelona Test (ABT), Global Dementia Staging (GDS), Functional Assessment Staging (FAST), Clinical Dementia Rating (CDR), Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), Interview for Deterioration in Daily life in Dementia (IDDD), Geriatric Evaluation by Relatives Rating Instrument (GERRI), Geriatric Depression Scale (GDS), Zung Self-Rating Anxiety Scale (ZSRAS). Descriptive statistics and analysis of variance. The characteristics of the sample were as follows.

CONTROLS

99 men, 155 women. Mean (SD) age: 64.6 (10.9) years. Mean (SD) educational level: 9.1 (4.9) years. DWD: 42 men, 44 women. Mean (SD) age: 65.8 (8.7) years. Men (SD) educational level: 8.4 (4.4) years. ATD: 48 mean, 63 women. Mean (SD) age: 68.3 (8.0) years. Mean (SD) educational level: 6.2 (4.3) years. The ATD patients were significantly older than the controls. Mean educational level was significantly lower in the ATD group than in the other two.