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Resumen Introduccion y objetivos Evaluar y comparar la utilidad diagnostica (UD) para el cribado de deterioro cognitivo (DC) de los test cognitivos breves (TCB) recomendados por la Guia de practica clinica sobre la atencion integral a las personas con enfermedad de Alzheimer y otras demencias. Material y metodos Estudio de fase iii de evaluacion de pruebas diagnosticas en el que se ha incluido en Atencion Primaria a sujetos con sospecha de DC. A todos se les ha aplicado Mini-Mental State Examination (Mini-Mental), Mini Examen Cognoscitivo (MEC), Short Portable Mental Status Questionnaire (SPMSQ), Memory Impairment Screen (MIS), test del reloj (TdR), Eurotest, Fototest y test de alteracion de memoria (T@M). El diagnostico de DC se ha realizado de forma independiente y cegada con respecto a los resultados de los TCB. La UD se ha evaluado mediante el area bajo la curva ROC (aROC). Resultados Se ha incluido a 141 sujetos (86 con DC). El Eurotest y el T@M (0,91 ± 0,02 [aROC ± EE] y 0,90 ± 0,02, respectivamente), los instrumentos que requieren mas tiempo (7,1 ± 1,8 [media ± DE] y 6,8 ± 2,2 min, respectivamente) tienen una UD significativamente superior a la del Mini-Mental, MEC, SPMSQ y TdR, pero no a la del MIS y Fototest (0,87 ± 0,03 ambas), requiriendo este ultimo menos de la mitad del tiempo (2,8 ± 0,8 min). T@M y MIS solo evaluan memoria y el ultimo no es aplicable a analfabetos. Conclusiones Los instrumentos mas recomendables para el cribado de DC en Atencion Primaria son Eurotest, T@M y Fototest, siendo el ultimo mas eficiente por requerir la mitad de tiempo.

Resumen Introduccion Una version pictorica del Free and Cued Selective Reminding Test (FCSRT) facilitaria la evaluacion de la memoria en pacientes con bajo nivel educativo. Una forma abreviada mejoraria la aplicacion. Objetivo Analizar la utilidad diagnostica de una version pictorica y abreviada del FCSRT para distinguir pacientes con deterioro cognitivo leve amnesico (DCLa) de controles, sin excluir a individuos con un nivel educativo bajo. Metodo Estudio en fase i de evaluacion de prueba diagnostica (muestreo de conveniencia, prevalencia pretest del 50%). El FCSRT fue administrado, de forma independiente y ciega al diagnostico, a 30 pacientes con DCLa (recomendaciones NIA-AA 2011) y a 30 controles emparejados por edad, genero, nivel educativo y grado de alfabetizacion, utilizando imagenes y obviando el ensayo diferido. Tres variables resultado fueron registradas: recuerdo libre total, recuerdo total e indice de sensibilidad a la pista. La utilidad diagnostica fue calculada mediante el area bajo la curva ROC. El indice Youden fue usado para seleccionar los mejores puntos de corte. Resultados El 41,7% de los participantes no habian completado estudios primarios. No hubo diferencias entre los 2 grupos respecto a las variables sociodemograficas. Las areas bajo la curva fueron optimas para recuerdo libre total (0,99), recuerdo total (0,95) e indice de sensibilidad a la pista (0,93). Los mejores puntos de corte fueron 21/22, 43/44 y Conclusion Esta evaluacion preliminar demuestra que una version pictorica y abreviada de FCSRT puede ser util y aplicable en el diagnostico de DCLa sin excluir a individuos con un nivel educativo bajo.

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

Resumen Introduccion y objetivos El Mini-Cog es un test cognitivo muy breve de uso extendido que incluye una tarea de memoria y una evaluacion simplificada del Test del Reloj (TdR). No existe una evaluacion formal del Mini-Cog en espanol; nuestro objetivo es analizar la utilidad diagnostica (UD) del Mini-Cog y del TdR para deterioro cognitivo (DC). Metodos Estudio transversal en el que se han incluido de forma sistematica todos los sujetos atendidos durante un semestre en una consulta de Neurologia. La UD se ha evaluado para DC (incluye sujetos con criterios NIA-AA de Mild Cognitive Impairment o demencia) por medio del area bajo la curva ROC (aROC). Se han calculado los parametros de sensibilidad (S), especificidad (E) y cocientes de probabilidad positivo y negativo (CP+, CP−) para los distintos puntos de corte. Resultados Se han incluido 581 sujetos (315 DC), 55,1% mujeres y 27,7% con bajo nivel educativo ( Conclusiones En consulta de Neurologia, el Mini-Cog tiene una UD para DC aceptable, superior a la del TdR; ninguno de ellos es un instrumento adecuado para ser utilizado en sujetos con bajo nivel educativo.

Patients in neurology clinics are sometimes not aware of the reason for the consultation, and we have called this circumstance the “Don’t know” sign (DKS). Our objective was to define this new sign and its modalities and to evaluate its prevalence and its diagnostic accuracy for cognitive impairment (CI) in comparison to other observation-based signs. A cross-sectional prospective study included all new outpatients evaluated by the authors at neurology consultation. We recorded observation-based signs. The Global Deterioration Scale (GDS) was used to assess the cognitive status of patients, based on clinical history, caregiver interview, and cognitive test results. We analyzed the prevalence and the diagnostic accuracy for CI of DKS, “head turning sign,” “attending with,” verbal repetition, and combinations, calculating sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). We enrolled 673 consecutive patients (62% female) with a mean ± SD age of 59.3 ± 20.2 years. DKS was positive in 94 patients (14%) and was strongly associated with GDS score. DKS had a Se of 0.41, Sp of 0.98, PPV of 0.89, and NPV of 0.79 for CI diagnosis. The presence of at least two positive observation signs yielded a Se of 0.50, Sp of 0.97, PPV of 0.86, and NPV of 0.81. DKS is frequently observed in neurology outpatients. It has low sensitivity but high specificity and PPV for CI diagnosis. It does not require additional consultation time, and its use can be recommended in combination with other observation-based signs.

Introduction: In the absence of a gold standard for in vivo Alzheimer disease (AD) diagnosis, AD biomarkers such as cerebrospinal fluid biomarkers (CSF-B) and PET-Amyloid are considered diagnostically useful in clinical practice guidelines and have consensual appropriate use criteria (AUC). However, little evidence has been published on their utilization in the clinical setting or on approaches to mismatched results. The objective of this work was to evaluate the use of AD biomarkers in clinical practice, focusing on the implementation of PET-Amyloid in cases of inconclusive CSF-B. Methods: This naturalistic, ambispective case series included patients fulfilling AUC for CSF-B and PET-Amyloid whose CSF-B results were non-diagnostic (target population), analyzing the diagnostic certainty, the treatment approach, and the relationship between CSF-B and PET-Amyloid results. Results: Out of 2373 eligible patients, AD biomarkers were studied in 417 (17.6%), most frequently due to cognitive impairment in under 65-year-olds, using CSF-B in 311 patients and PET-Amyloid in 150. CSF-B results were non-diagnostic for 44 patients (52.3% male; aged 60.9±6.6 years), who then underwent PET-Amyloid study, which was positive in 31. A ‘k’ coefficient of 0.108 was obtained between CSF-B and PET-amyloid (54.5% concordance). In multivariate regression analysis, Aβ42 was the only significant predictor (p= 0.018) of a positive PET-Amyloid result. In the target population, PETAmyloid increased diagnostic confidence by 53.7% (p Conclusion: These findings support the duplication of AD biomarkers and demonstrate that the implementation of PET-Amyloid provides an early and certain diagnosis to guide appropriate treatment.

Background: Neurologic impairment persisting months after acute severe SARS-CoV-2 infection has been described because of several pathogenic mechanisms, including persistent systemic inflammation. The objective of this study is to analyze the selective involvement of the different cognitive domains, it impacts on quality of life and the possible existence of related biomarkers.Methods: Cross-sectional study of patients who survived severe infection with SARS-CoV-2 consecutively recruited from 13 neurology services in Spain between 90 and 120 days after hospital discharge. All patients underwent an exhaustive study of cognitive functions as well as plasma determination of pro-inflammatory factors (chemokines), and neurotrophic factors and light-chain neurofilaments. A Principal Component Analysis extracted the main independent characteristics of the syndrome.Results: 152 patients were recruited. The results of our study show a pattern of cognitive impairment with preferential involvement of episodic and working memory, executive functions, and attention and relatively less affectation of information processing speed, denomination, verbal fluency, and other cortical functions. In addition, psychiatric affectation such as anxiety and depression pictures are constant in our cohort. Several plasma chemokines concentrations were elevated compared with both, a non-SARS-Cov2 infected cohort of neurological outpatients or a control healthy general population, suggesting a pro-inflammatory chronic state derived of viral infection.Conclusion: The neurologic Subacute Impairment in severe Covid-19 consist in an amnesic and dysexecutive syndrome with neuropsychiatric manifestations. We do not know if the deficits detected can persist in the long term and, in this case, if this can trigger or accelerate the onset of neurodegenerative diseases.

Patients in neurology clinics are sometimes not aware of the reason for the consultation, and we have called this circumstance the "Don't know" sign (DKS). Our objective was to define this new sign and its modalities and to evaluate its prevalence and its diagnostic accuracy for cognitive impairment (CI) in comparison to other observation-based signs.A cross-sectional prospective study included all new outpatients evaluated by the authors at neurology consultation.We recorded observation-based signs. The Global Deterioration Scale (GDS) was used to assess the cognitive status of patients, based on clinical history, caregiver interview, and cognitive test results. We analyzed the prevalence and the diagnostic accuracy for CI of DKS, "head turning sign," "attending with," verbal repetition, and combinations, calculating sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV).We enrolled 673 consecutive patients (62% female) with a mean ± SD age of 59.3 ± 20.2 years. DKS was positive in 94 patients (14%) and was strongly associated with GDS score. DKS had a Se of 0.41, Sp of 0.98, PPV of 0.89, and NPV of 0.79 for CI diagnosis. The presence of at least two positive observation signs yielded a Se of 0.50, Sp of 0.97, PPV of 0.86, and NPV of 0.81.DKS is frequently observed in neurology outpatients. It has low sensitivity but high specificity and PPV for CI diagnosis. It does not require additional consultation time, and its use can be recommended in combination with other observation-based signs.

Resumen Introduccion El Fototest y el Mini-Cog incluyen todos los dominios que debieran formar parte de una evaluacion cognitiva. Nuestro objetivo es evaluar la utilidad diagnostica del uso conjunto de ambos instrumentos para el diagnostico de deterioro cognitivo (DC). Metodos Estudio fase iii de evaluacion de pruebas diagnosticas con 2 muestras independientes, estudio (448 sujetos), dividida aleatoriamente en 2 dataset (Base 80%, Test 20%), y Externa (61 sujetos). Prueba index: Fototest y Mini-Cog aplicados consecutivamente; prueba de referencia: evaluacion cognitiva formal. Se evalua la UD del uso combinado y escalonado de los modelos simple (Comb-Simple), regresion logistica (Comb-RL) y arbol aleatorio (Comb-AA) para identificar DC (GDS ≥ 3). Se realiza un analisis exploratorio en Base seleccionando los criterios que maximizan la exactitud; la evaluacion se realiza en las muestras Test y externa mediante un analisis preespecificado con los criterios seleccionados. Resultados La UD de los modelos combinados en Base (Comb-Simple 88,3 [(88,5-91,4] [exactitud, LI95%-LS95%], Comb-RL 91.6 [88,2-94,3] y Comb-AA 95,2 [92,5-97,2])) es significativamente superior a la de Mini-Cog y Fototest (81,6 [77,1-85,4] y 84,9 [80,8-88,5], respectivamente); estos resultados son replicados en Test (Comb-Simple 88,9 [exactitud], Comb-RL 95,6 y Comb-AA 92,2) y externa (Comb-Simple 91,8, Comb-RL 90,2 y Comb-AA 88,5). La aplicacion escalonada mantiene la misma UD pero requiere menos tiempo (197,3 ± 56,7 vs. 233,9 ± 45,2, p Conclusiones El uso conjunto del Fototest y el Mini-Cog requiere menos de 4 min y mejora la UD de ambos instrumentos. El uso escalonado es mas eficiente porque manteniendo la misma UD requiere menos tiempo de aplicacion.

BACKGROUND Biomarkers of neurodegeneration play a major role in the diagnosis of Alzheimer's disease (AD). Information on both amyloid-β accumulation, e.g., from amyloid positron emission tomography (PET), and downstream neuronal injury, e.g., from 18F-fluorodeoxyglucose (FDG) PET, would ideally be obtained in a single procedure. OBJECTIVE On the basis that the parallelism between brain perfusion and glucose metabolism is well documented, the objective of this work is to evaluate whether brain perfusion estimated in a dual-point protocol of 18F-florbetaben (FBB) PET can be a surrogate of FDG PET in appropriate use criteria (AUC) for amyloid PET. METHODS This study included 47 patients fulfilling international AUC for amyloid PET. FDG PET, early FBB (pFBB) PET (0-10 min post injection), and standard FBB (sFBB) PET (90-110 min post injection) scans were acquired. Results of clinical subjective reports and of quantitative region of interest (ROI)-based analyses were compared between procedures using statistical techniques such as Pearson's correlation coefficients and t-tests. RESULTS pFBB and FDG visual reports on the 47 patients showed good agreement (k > 0.74); ROI quantitative analysis indicated that both data modalities are highly correlated; and the t-test analysis does not reject the null hypothesis that data from pFBB and FDG examinations comes from independent random samples from normal distributions with equal means and variances. CONCLUSIONS A good agreement was found between pFBB and FDG data as obtained by subjective visual and quantitative analyses. Dual-point FBB PET scans could offer complementary information (similar to that from FDG PET and FBB PET) in a single procedure, considering pFBB as a surrogate of FDG.

To evaluate the use of amyloid-positron emission tomography (PET) in routine clinical practice, in a selected population with cognitive impairment that meets appropriate use criteria (AUC). A multicenter, observational, prospective case-series study of 211patients from 2 level-3 hospitals who fulfilled clinical AUC for amyloid-PET scan in a naturalistic setting. Certainty degree was evaluated using a 5-point Likert scale: 0 (very low probability); 1 (low probability); 2 (intermediate probability); 3 (high probability); and 4 (practically sure), before and after amyloid PET. The treatment plan was considered as cognition-specific or noncognition-specific. Amyloid-PET was positive in 118 patients (55.9%) and negative in 93 patients (44.1%). Diagnostic prescan confidence according amyloid-PET results showed that in both, negative and positive-PET subgroup, the most frequent category was intermediate probability (45.7% and 55.1%, respectively). After the amyloid-PET, the diagnostic confidence showed a very different distribution, that was, in the negative-PET group the most frequent categories are very unlikely (70.7%) and unlikely (29.3%), while in the positive- PET group were very probable (57.6%) and practically sure (39%). Only in 14/211 patients (6.6%) the result of the amyloid-PET did not influence the diagnostic confidence, while in 194 patients (93.4%), the diagnostic confidence improved significantly after amyloid- PET results. The therapeutic intention was modified in 93 patients (44.1%). Specific treatment for Alzheimer disease was started, before amyloid-PET, in 80 patients (37.9%). This naturalistic study provides evidence that the implementation of amyloid-PET is associated with a significant improvement in diagnostic confidence and has a high impact on the therapeutic management of patients with mild cognitive impairment fulfilled clinical AUC.

Background:TMA-93 examines binding by images, an advantage for the less educated individuals.Aim:To compare the discriminative validity of TMA-93 against the picture version of Free and Cued Selective Reminding Test (FCSRT) to distinguish patients with amnestic mild cognitive impairment (aMCI) from normal controls (NCs) without excluding less educated individuals.Methods:Design:Phase I diagnostic evaluation study.Participants:A total of 30 patients with aMCI and 30 NCs matched for sociodemographics variables.Statistical Analysis:The diagnostic accuracy for each test was calculated by conducting receiver operating characteristic curve analysis. Hanley and McNeil method was used to compare diagnostic accuracy of different tests on the same sample.Results:Up to 41.7% of the sample had less than a first grade of education. Both tests showed excellent diagnostic accuracy. The comparisons did not show significant differences.Conclusions:TMA-93 is so accurate as FCSRT to differentiate aMCI from controls including less educated individuals. The test could be considered as a choice in this sociodemographic context.

The control of bacterial dental plaque through daily oral hygiene is essential to prevent oral diseases such as caries or periodontal disease, especially in at-risk populations, including the elderly with mild cognitive impairment and dementia. The aim of this study was to determine the association between different levels of cognitive impairment and dementia in an elderly population and their capacity to maintain adequate oral hygiene. A case-control study (elderly with versus without mild cognitive impairment or dementia) was performed in Granada, Spain. Outcome variables were tooth/prosthesis-brushing frequency/day, bacterial plaque index, and gingival bleeding index. Statistical models were adjusted by age, sex, educational level, and tobacco and alcohol habits. The study included 240 cases and 324 controls. The final model, adjusted by age, sex, educational level, and tobacco and alcohol consumption, showed a significant association between degree of cognitive impairment and daily oral hygiene, accumulation of bacterial plaque, and gingival bleeding. In summary, deficient daily oral hygiene, evidenced by greater bacterial dental plaque accumulation and gingival inflammation, is independently associated with cognitive impairment, even at its earliest stage.

Older adults, especially those with cognitive impairment or dementia, frequently consume drugs with potential xerostomic effects that impair their quality of life and oral health. The objective of this study was to determine the prevalence and analyze the possible pharmacological etiology of xerostomia in older people with or without cognitive impairment. Individuals with cognitive impairment were recruited from patients diagnosed using standardized criteria in two neurology departments in Southern Spain. A comparison group was recruited from healthcare centers in the same city after ruling out cognitive impairment. Data on oral health, xerostomia, and drug consumption were recorded in both groups. Dry mouth was evaluated using a 1-item questionnaire and recording clinical signs of oral dryness. All drugs consumed by the participants were recorded, including memantine, anticholinesterases, antipsychotics, antidepressants, and anxiolytics. The final sample comprised 200 individuals with mild cognitive impairment or dementia and 156 without. Xerostomia was present in 70.5 % of participants with cognitive impairment versus 36.5 % of those without, regardless of the drug consumed. Memantine consumption was the only variable significantly related to xerostomia in the multivariate model (OR 3.1; 95 % CI 1.1–8.7), and this relationship persisted after adjusting for possible confounders and forcing the inclusion of drugs with xerostomic potential. More than 70 % of participants diagnosed with cognitive impairment or dementia had xerostomia. Anticholinesterases and memantine were both associated with the presence of xerostomia. In the case of memantine, this association was independent of the consumption of the other drugs considered.

Introduction A picture version of the Free and Cued Selective Reminding Test (FCSRT) would assist in the assessment of memory function in patients with low levels of schooling. A shortened version would improve the test's applicability. Objectives To analyse the diagnostic usefulness of a shortened picture version of the FCSRT for distinguishing patients with amnestic mild cognitive impairment (aMCI) from controls, without excluding participants with a low level of schooling. Methods Phase I study of a diagnostic evaluation (convenience sampling; pre-test prevalence 50%). A blinded researcher independently administered the FCSRT to 30 patients with aMCI and 30 controls matched for age, sex, level of schooling and literacy, using images and omitting the usual 30-minutes delayed recall item. Three variables were recorded: free recall, total recall, and cue efficiency. Diagnostic accuracy was calculated using receiver operating characteristic curves and the area under the curve. The Youden index was used to identify optimal cut-off points. Results Of all participants, 41.7% had not completed primary education. There were no differences between groups as regards sociodemographic variables. Area under the curve was excellent for free recall (0.99), total recall (0.95), and cue efficiency (0.93). The optimal cut-off points were 21/22, 43/44, and Conclusions This preliminary analysis shows that a shortened picture version of the FCSRT may be useful and applicable for the diagnosis of aMCI without excluding individuals with a low level of schooling.

Resumen: Introducción: Los test cognitivos breves (TCB) son instrumentos de uso habitual en la práctica clínica para la detección y el cribado del deterioro cognitivo y demencia. Los TCB deben reunir unas características de aplicabilidad y psicométricas mínimas. Desarrollo: El Mini-Mental es el TCB más utilizado y el artículo en el que se describe es un hito en la historia de la Medicina. Su principal ventaja es la amplia difusión de su uso y el extenso soporte empírico que la apoya. No obstante, el Mini-Mental tiene numerosas e importantes limitaciones, fundamentalmente la falta de estandarización, el no poder ser aplicado a analfabetos, la gran influencia en sus resultados de las variables socioeducativas y la discreta utilidad para la detección de DC; además, este instrumento está protegido por copyright por lo que su uso es gravoso o fraudulento. En la actualidad, hay TCB disponibles que no cuentan con estas limitaciones y que han mostrado una mayor utilidad diagnóstica e incluso un mayor coste-efectividad que el Mini-Mental en la detección de deterioro cognitivo y demencia. Conclusión: Es hora de reconocerle al Mini-Mental el importante papel que ha desempeñado en la historia de la Medicina y concederle una merecida y honrosa jubilación, dando paso a instrumentos más breves, fáciles y baratos, que puedan ser aplicados libremente a todos los individuos y que sean más eficientes y justos. Abstract: Introduction: Short cognitive tests are routinely used in clinical practice to detect and screen for cognitive impairment and dementia. These cognitive tests should meet minimum criteria for both applicability and psychometric qualities. Development: The Mini-Mental State Examination (MMSE) is the most frequently applied short cognitive test, and the article introducing it remains a milestone in the history of medicine. Its main advantages are its widespread use and the extensive empirical evidence that supports it. However, the MMSE has important shortcomings, including lack of standardisation, its lack of suitability for illiterate subjects, the considerable effect of socio-educational variables on results, and its limited effectiveness for detecting cognitive impairment. Lastly, since the test is copyright-protected, using it is necessarily either costly or fraudulent. Newer available instruments do not share these shortcomings and have demonstrated greater diagnostic accuracy for detecting cognitive impairment and dementia, as well as being more cost-effective than the MMSE Conclusion: It is time to acknowledge the MMSE's important role in the history of medicine and grant it a deserved and honourable retirement. Its place will be taken by more effective instruments that require less time, are user-friendly and free of charge, can be applied to all individuals, and yield more equitable outcomes. Palabras clave: Mini-Mental, Test de cribado, Test cognitivos breves, Demencia, Deterioro cognitivo, Evaluación cognitiva abreviada, Keywords: Mini-Mental, Screening test, Short cognitive test, Dementia, Cognitive impairment, Abbreviated cognitive evaluation

ResumenObjetivoEvaluar la utilidad diagnóstica (UD) del Mini-Mental (MMS) en la detección del deterioro cognitivo (DC) en Atención Primaria (AP) y determinar las mejores condiciones de aplicación para este fin.DiseñoAnálisis conjunto de 2 estudios de evaluación de pruebas diagnósticas prospectivos con selección consecutiva y sistemática, verificación completa y doble cegamiento, realizados en Madrid y Granada.EmplazamientoEl MMS fue aplicado en AP y el diagnóstico de referencia en Atención Especializada.ParticipantesSe seleccionaron de forma consecutiva y sistemática sujetos con quejas o sospecha de DC atendidos en AP.Mediciones principalesLa UD del MMS se evaluó mediante el área bajo la curva ROC (AUC) y se consideró mejor punto de corte el que ofrecía la mayor tasa de aciertos diagnósticos (TAD) y el mayor índice kappa. Se analizó de forma independiente la UD para las puntuaciones directas (MMSd) y ajustadas por edad y nivel educativo (MMSa)ResultadosEn la muestra total de 360 sujetos (214 DC), la UD de MMSd fue significativamente superior a la de MMSa (0,84±0,02 vs 0,82±0,02, p≤0,001). El rendimiento diagnóstico conseguido por el MMSd con el mejor punto de corte (22/23) fue discreto (TAD 0,77, kappa 0,52±0,05), pero no fue mejorado por ningún punto de corte del MMSa.ConclusiónEl Mini-Mental tiene una UD discreta para la detección de DC en AP que no mejora con la corrección de las puntuaciones por edad y nivel educativo; el mejor punto de corte es 22/23, inferior al habitualmente recomendado.AbstractObjectiveTo evaluate the diagnostic accuracy (DA) of the Mini-Mental State (MMS) for the detection of cognitive impairment (CI) in Primary Care (PC) and to determine the best conditions of use for that purpose.DesignPooled analysis of two prospective, double blind, studies on the evaluation of diagnostic tools with complete verification that were conducted in Madrid and Granada (Spain).SettingThe MMS was administered in PC and the final cognitive diagnosis (gold standard) was made in Specialized Care.ParticipantsSubjects with cognitive complaints or suspected of having CI were consecutively recruited in the PC clinic.Principal measuresThe DA of the MMS was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best cut-off point was selected according to the ratio of cases correctly classified (RCC) and to the kappa index. Direct (MMSd) and age- and education-adjusted (MMSa) total scores were analyzed separately.ResultsIn the total sample of 360 subjects (214 CI), the DA of the MMSd was significantly superior to that of the MMSa (0.84±0.02 vs 0.82±0.02, p≤.001). The yield obtained by the best cut-off point of the MMSd (22/23) was modest (RCC 0.77, kappa 0.52±0.05) and was not improved by any MMSa cut-off point.ConclusionThe DA of the MMS for detection of CI in PC was modest and did not improve with adjustment of the score by age and education. The best cut-off point was 22/23, inferior to the usually recommended cut-off.

Resumen: Introducción y objetivos: La escala Relevant Outcome Scale for Alzheimer's Disease (ROSA) es una herramienta útil para la evaluación y seguimiento de pacientes con demencia. Nuestro objetivo es evaluar la validez y fiabilidad de una versión española de la escala ROSA. Pacientes y métodos: Estudio multicéntrico nacional en el que 39 investigadores han incluido 237 sujetos con enfermedad de Alzheimer (78 en estadio leve, 79 moderado y 80 grave) a los que se les ha aplicado Mini-Mental, Fototest, Neuropsychiatric Inventory (NPI), escala de Blessed y una versión adaptada al español de la escala ROSA. En una submuestra de 40 sujetos se realizó un retest en los 14 días siguientes a la evaluación inicial. La validez de constructo se ha evaluado mediante el coeficiente correlación de Spearman (r), la consistencia interna con el coeficiente alfa de Cronbach (alfa) y la fiabilidad test-retest con el coeficiente correlación intraclase (CCI). Resultados: La escala ROSA se aplica en 13,8 ± 7,4 min y sus resultados están asociados de forma significativa al estadio clínico (leve 116,7 ± 23,1, moderado 92,9 ± 19,8 y grave 64,3 ± 22,6), Mini-Mental (r = 0,68), Fototest (r = 0,63), NPI (r = 0,53) y escala de Blessed (r = –0,80). La escala ROSA muestra una alta consistencia interna (alfa = 0,90) y una excelente fiabilidad test-retest (CCI = 0,97). Conclusión: La versión española de la escala ROSA es un instrumento breve, válido y fiable para la evaluación global de pacientes con demencia. Abstract: Introduction and objectives: The Relevant Outcome Scale for Alzheimer's Disease (ROSA) is a useful tool for evaluating and monitoring dementia patients. This study aims to evaluate the validity and reliability of the Spanish version of ROSA. Patients and methods: Spanish multicentre study involving 39 researchers and including 237 patients with Alzheimer disease (78 mild, 79 moderate, and 80 severe). The patients were tested with the following: Mini–Mental State Examination (MMSE), Fototest, Neuropsychiatric Inventory (NPI), Blessed dementia scale, and a Spanish-language version of ROSA. A subsample of 40 subjects was retested in the 14 days following the initial evaluation. The construct validity was evaluated with the Spearman correlation coefficient (r), internal consistency with Cronbach's alpha (alpha), and test-retest reliability with the intraclass correlation coefficient (ICC). Results: ROSA requires 13.8 ± 7.4 minutes to administer and its results show a significant association with the clinical stage of AD (mild, 116.7 ± 23.1; moderate, 92.9 ± 19.8; and severe, 64.3 ± 22.6), and with results on the MMSE (r=0.68), Fototest (r=0.63), NPI (r=0.53), and Blessed dementia scale (r = –0.80). ROSA shows high internal consistency (alpha = 0.90) and excellent test-retest reliability (ICC 0.97). Conclusion: The Spanish version of ROSA is a brief, valid, and reliable tool permitting overall evaluation of patients with dementia. Palabras clave: Enfermedad de Alzheimer, Demencia, Escala ROSA, Fiabilidad, Validez, Keywords: Alzheimer disease, Dementia, ROSA scale, Reliability, Validity

Vanishing white matter disease (VWM) was described by Van der Knaap in 1996. This association with premature ovarian failure is known as ovarioleukodystrophy. This is a rare entity caused by a mutation in one of the subunits of eukaryotic initiation factor 2B (EIF2B). The onset in adulthood or late in adolescence is very infrequent. A 41-years-old woman and her 37-years-old sister developed epilepsy in association with premature ovarian failure at the age of 13 and 18 respectively. The oldest-one started 17 years later progressive subcortical cognitive decline with predominant behavioural disorders and a progressive spastic paraparesis in association with symmetric cystic changes in the with matter of both hemispheres. In both patients we found the c.1117C>T (p.Arg373Cys) mutation in homozygosis in the EIF2B4 gen.

Objective: Fototest is a short simple test, applicable to illiterate subjects and not influenced by educational level. The purpose of this study is to assess its validity for cognitive impairment (CI) and dementia (DEM) under routine clinical practice conditions. Material and methods: A cross-sectional, multicentre and naturalistic study conducted in General Neurology clinics. The subjects were over 60 years old, with a previously established diagnosis of no cognitive impairment (NoCI), cognitive impairment without dementia (CInoDEM), or dementia (DEM). The discriminant validity was assessed using the area under the ROC curve (AUC), sensitivity (Sn), specificity (Sp), and probability coefficients. Partial correlations were calculated, adjusted for age, sex and education level with Eurotest, verbal fluency test (VFT) and Global Deterioration Scale (GDS) score to evaluate the concurrent and construct validity. Results: Nineteen neurologists included a total of 589 subjects: 361 NoCI, 106 CINoDEM and 122 DEM. The discriminant value was better for DEM (AUC 0.94 ± 0.02) than for CI (0.86 ± 0.02). For DEM the best cut-off point was 26/27 (Sn = 0.88 [95% CI, 0.93-0.97], Sp = 0.87 [95% CI, 0.84–0.90]); and for CI, 28/29 (Sn = 0.71 [95% CI, 0.65–0.77], Sp = 0.84 [95% CI, 0.80–0.88]). Fototest showed a high and significant correlation with Eurotest (r = 0.70 ± 0.02), VFT (r = 0.68 ± 0.02) and the GDS score (r = −0.77 ± 0.02). Conclusion: The Fototest showed adequate validity for CI and DEM in general neurology clinics in an extensive and wide geographical area. Resumen: Objetivo: El Fototest es un test breve, fácil, aplicable a analfabetos y no influido por el nivel educativo. El objetivo de este estudio es evaluar su validez para deterioro cognitivo (DC) y demencia (DEM) en condiciones de práctica clínica habitual. Material y métodos: Estudio transversal multicéntrico y naturalístico realizado en consultas de neurología general. Se incluyó a sujetos mayores de 60 años con diagnóstico previamente establecido de no deterioro cognitivo (NoDC), deterioro cognitivo sin demencia (DCsD) o demencia (DEM). La validez discriminativa se evaluó mediante el área bajo la curva ROC (aROC), sensibilidad (S), especificidad (E) y cocientes de probabilidad. Se calcularon correlaciones parciales ajustadas por edad, sexo y nivel educativo con Eurotest, fluidez verbal semántica (FVS) y el estadio GDS para evaluar la validez concurrente y de constructo. Resultados: Diecinueve neurólogos incluyeron a un total de 589 sujetos: 361 NoDC, 106 DCsD y 122 DEM. La validez discriminativa es mejor para DEM (aROC 0,94 ± 0,02) que para DC (0,86 ± 0,02). Para DEM el mejor punto de corte es 26/27 (S = 0,88 [IC del 95%, 0,93-0,97], E = 0,87 [IC del 95%, 0,84-0,90]), y para DC, 28/29 (S = 0,71 [IC del 95%, 0,65-0,77], E = 0,84 [IC del 95%, 0,80-0,88]). El Fototest muestra una alta y significativa correlación con el Eurotest (r = 0,70 ± 0,02), la FVS (r = 0,68 ± 0,02) y el estadio GDS (r = –0,77 ± 0,02). Conclusión: El Fototest muestra una adecuada validez para DC y DEM, en consultas generales de neurología de un extenso y variado ámbito geográfico. Keywords: Screening test, Short cognitive test, Fototest, Cognitive impairment, Dementia, Palabras clave: Test de cribado, Test cognitivo breve, Fototest, Deterioro cognitivo, Demencia

Introduction: The Fototest is a brief cognitive test suitable for illiterate persons, and valid and accurate for detecting cognitive impairment or dementia. Our aim was to conclude the development of this instrument carrying out a normative and reliability study. Method: The normative study was performed on a convenience sample of 223 healthy volunteers aged between 20 and 85 years. The test-retest reliability was assessed through a repeated-measures cross-sectional design on a sample of 50 subjects with no cognitive impairment; the inter-rater reliability was determined by the blind assessment of 10 test applications performed by 30 independent observers; in both instances, reliability was expressed as intra-class correlation coefficient. Internal consistency was analysed by Cronbach's alpha coefficient. Results: The results on the Fototest are normally distributed and are not influenced by gender or educational level but they do vary with age. The test-retest reliability of the Fototest was 0.89 (95% CI: 0.81–0.93); the inter-rater reliability, 0.98 (95% CI: 0.96–0.99); and the internal consistency, 0.94. Conclusions: The Fototest is free from educational influence and shows appropriate testretest and inter-rater reliabilities, as well as a high internal consistency. Therefore, it is a suitable psychometric instrument to be used in the follow-up of patients with cognitive impairment or dementia, especially in contexts where evaluators are not the same on different occasions, or with patients of low educational level. Resumen: Introducción: El Fototest es un test cognitivo breve aplicable a analfabetos, válido y útil para la detección de deterioro cognitivo y demencia. Nuestro objetivo es completar el proceso de desarrollo del instrumento llevando a cabo un estudio normativo y de fiabilidad. Métodos: El estudio normativo se realizó en una muestra de conveniencia de 223 sujetos voluntarios sanos entre 20 y 85 años. La fiabilidad test-retest (Ftr) se evaluó mediante un diseño transversal de medidas repetidas en una muestra de 50 sujetos sin deterioro cognitivo; la fiabilidad interobservador (Fio) se determinó mediante la evaluación a ciegas de 10 aplicaciones del test por 30 observadores independientes; en ambos casos se utilizó el coeficiente de correlación intraclase. La evaluación de la consistencia interna (CI) se llevó a cabo mediante el coeficiente alfa de Cronbach. Resultados: Los resultados del Fototest se distribuyen normalmente y no están influenciados por el sexo ni el nivel educativo, pero sí por la edad. La Ftr del Fototest es 0,89 (IC 95%: 0.81–0.93), la Fio es de 0,98 (IC 95%: 0.96–0.99) y 0,94 la CI. Conclusiones: El Fototest está libre de influencias educativas y tiene una adecuada fiabilidad, tanto Ftr como Fio, y una alta consistencia interna, por tanto, es un instrumento adecuado para ser usado en el seguimiento de pacientes con deterioro cognitivo y demencia sobre todo en entornos en que cambien los evaluadores, en especial en poblaciones con bajo nivel educativo. Keywords: Screening Test, Test cognitive short, Fototest, Interobserver reliability, Test-retest reliability, Test of the photos, Standardization, Palabras clave: Test de Cribado, Tests cognitivos breves, Fototest, Fiabilidad interobservador, Fiabilidad test-retest, Test de las Fotos, Normalización

Resumen: Introducción: El Fototest es un test cognitivo breve aplicable a analfabetos, válido y útil para la detección de deterioro cognitivo y demencia. Nuestro objetivo es completar el proceso de desarrollo del instrumento llevando a cabo un estudio normativo y de fiabilidad. Métodos: El estudio normativo se realizó en una muestra de conveniencia de 223 sujetos voluntarios sanos entre 20 y 85 años. La fiabilidad test-retest (Ftr) se evaluó mediante un diseño transversal de medidas repetidas en una muestra de 50 sujetos sin deterioro cognitivo; la fiabilidad interobservador (Fio) se determinó mediante la evaluación a ciegas de 10 aplicaciones del test por 30 observadores independientes; en ambos casos se utilizó el coeficiente de correlación intraclase. La evaluación de la consistencia interna (CI) se llevó a cabo mediante el coeficiente alfa de Cronbach. Resultados: Los resultados del Fototest se distribuyen normalmente y no están influenciados por el sexo ni el nivel educativo, pero sí por la edad. La Ftr del Fototest es 0,89 (IC 95%: 0,81-0,93), la Fio es de 0,98 (IC 95%: 0,96-0,99) y 0,94 la CI. Conclusiones: El Fototest está libre de influencias educativas y tiene una adecuada fiabilidad, tanto Ftr como Fio, y una alta consistencia interna, por tanto, es un instrumento adecuado para ser usado en el seguimiento de pacientes con deterioro cognitivo y demencia sobre todo en entornos en que cambien los evaluadores, en especial en poblaciones con bajo nivel educativo. Abstract: Introduction: The Fototest is a brief cognitive test suitable for illiterate persons, and valid and accurate for detecting cognitive impairment or dementia. Our aim was to conclude the development of this instrument carrying out a normative and reliability study. Method: The normative study was performed on a convenience sample of 223 healthy volunteers aged between 20 and 85 years. The test-retest reliability was assessed through a repeated-measures cross-sectional design on a sample of 50 subjects with no cognitive impairment; the inter-rater reliability was determined by the blind assessment of 10 test applications performed by 30 independent observers; in both instances, reliability was expressed as intra-class correlation coefficient. Internal consistency was analysed by Cronbach's alpha coefficient. Results: The results on the Fototest are normally distributed and are not influenced by gender or educational level but they do vary with age. The test-retest reliability of the Fototest was 0.89 (95% CI: 0.81-0.93); the inter-rater reliability, 0.98 (95% CI: 0.96-0.99); and the internal consistency, 0.94. Conclusions: The Fototest is free from educational influence and shows appropriate test-retest and inter-rater reliabilities, as well as a high internal consistency. Therefore, it is a suitable psychometric instrument to be used in the follow-up of patients with cognitive impairment or dementia, especially in contexts where evaluators are not the same on different occasions, or with patients of low educational level. Palabras clave: Test de Cribado, Tests cognitivos breves, Fototest, Fiabilidad interobservador, Fiabilidad test-retest, Test de las Fotos, Normalización, Keywords: Screening Test, Test cognitive short, Fototest, Interobserver reliability, Test-retest reliability, Test of the photos, Standardization

Introduction: Brief cognitive tests (BCT) may help detect cognitive impairment (CI) in the clinical setting. Several BCT have been developed and/or validated in our country, but we lack specific recommendations for use. Development: Review of studies on the diagnostic accuracy of BCT for CI, using studies conducted in Spain with BCT which take less than 20 minutes. We provide recommendations of use based on expert consensus and established on the basis of BCT characteristics and study results. Conclusion: The Fototest, the Memory Impairment Screen (MIS) and the Mini-Mental State Examination (MMSE) are the preferred options in primary care; other BCT (Clock Drawing Test [CDT], test of verbal fluency [TVF]) may also be administered in cases of negative results with persistent suspected CI or concern (stepwise approach). In the specialised care setting, a systematic assessment of the different cognitive domains should be conducted using the Montreal Cognitive Assessment, the MMSE, the Rowland Universal Dementia Assessment, the Addenbrooke's Cognitive Examination, or by means of a stepwise or combined approach involving more simple tests (CDT, TVF, Fototest, MIS, Memory Alteration Test, Eurotest). Associating an informant questionnaire (IQ) with the BCT is superior to the BCT alone for the detection of CI.The choice of instruments will depend on the patient's characteristics, the clinician's experience, and available time. The BCT and IQ must reinforce—but never substitute—clinical judgement, patient–doctor communication, and inter-professional dialogue. Resumen: Introducción: Los test cognitivos breves (TCB) pueden ayudar a detectar el deterioro cognitivo (DC) en el ámbito asistencial. Se han desarrollado y/o validado varios TCB en nuestro país, pero no existen recomendaciones específicas para su uso. Desarrollo: Revisión de estudios sobre el rendimiento diagnóstico en la detección del DC llevados a cabo en España con TCB que requieran menos de 20 min y recomendaciones de uso consensuadas por expertos, sobre la base de las características de los TCB y de los estudios disponibles. Conclusión: El Fototest, el Memory Impairment Screen (MIS) y el Mini-Mental State Examination (MMSE) son las opciones más recomendables para el primer nivel asistencial, pudiendo añadirse otros test (Test del Reloj [TR] y test de fluidez verbal [TFV]) en caso de resultado negativo y queja o sospecha persistente (aproximación escalonada). En el segundo nivel asistencial es conveniente una evaluación sistemática de las distintas áreas cognitivas, que puede llevarse a cabo con instrumentos como el Montreal Cognitive Assessment, el MMSE, el Rowland Universal Dementia Assessment o el Addenbrooke's Cognitive Examination, o bien mediante el uso escalonado o combinado de herramientas más simples (TR, TFV, Fototest, MIS, Test de Alteración de la Memoria y Eurotest). El uso asociado de cuestionarios cumplimentados por un informador (CCI) aporta valor añadido a los TCB en la detección del DC.La elección de los instrumentos vendrá condicionada por las características del paciente, la experiencia del clínico y el tiempo disponible. Los TCB y los CCI deben reforzar —pero nunca suplantar— el juicio clínico, la comunicación con el paciente y el diálogo interprofesional. Keywords: Brief cognitive tests, Cognitive impairment, Detection, Screening, Primary care, Specialised care, Palabras clave: Test cognitivos breves, Deterioro cognitivo, Detección, Cribado, Atención primaria, Atención especializada

Resumen: Introducción: Los test cognitivos breves (TCB) pueden ayudar a detectar el deterioro cognitivo (DC) en el ámbito asistencial. Se han desarrollado y/o validado varios TCB en nuestro país, pero no existen recomendaciones específicas para su uso. Desarrollo: Revisión de estudios sobre el rendimiento diagnóstico en la detección del DC llevados a cabo en España con TCB que requieran menos de 20 min y recomendaciones de uso consensuadas por expertos, sobre la base de las características de los TCB y de los estudios disponibles. Conclusión: El Fototest, el Memory Impairment Screen (MIS) y el Mini-Mental State Examination (MMSE) son las opciones más recomendables para el primer nivel asistencial, pudiendo añadirse otros test (Test del Reloj [TR] y test de fluidez verbal [TFV]) en caso de resultado negativo y queja o sospecha persistente (aproximación escalonada). En el segundo nivel asistencial es conveniente una evaluación sistemática de las distintas áreas cognitivas, que puede llevarse a cabo con instrumentos como el Montreal Cognitive Assessment, el MMSE, el Rowland Universal Dementia Assessment o el Addenbrooke's Cognitive Examination, o bien mediante el uso escalonado o combinado de herramientas más simples (TR, TFV, Fototest, MIS, Test de Alteración de la Memoria y Eurotest). El uso asociado de cuestionarios cumplimentados por un informador (CCI) aporta valor añadido a los TCB en la detección del DC.La elección de los instrumentos vendrá condicionada por las características del paciente, la experiencia del clínico y el tiempo disponible. Los TCB y los CCI deben reforzar —pero nunca suplantar— el juicio clínico, la comunicación con el paciente y el diálogo interprofesional. Abstract: Introduction: Brief cognitive tests (BCT) may help detect cognitive impairment (CI) in the clinical setting. Several BCT have been developed and/or validated in our country, but we lack specific recommendations for use. Development: Review of studies on the diagnostic accuracy of BCT for CI, using studies conducted in Spain with BCT which take less than 20 min. We provide recommendations of use based on expert consensus and established on the basis of BCT characteristics and study results. Conclusion: The Fototest, the Memory Impairment Screen (MIS) and the Mini-Mental State Examination (MMSE) are the preferred options in primary care; other BCT (Clock Drawing Test [CDT], test of verbal fluency [TVF]) may also be administered in cases of negative results with persistent suspected CI or concern (stepwise approach). In the specialised care setting, a systematic assessment of the different cognitive domains should be conducted using the Montreal Cognitive Assessment, the MMSE, the Rowland Universal Dementia Assessment, the Addenbrooke's Cognitive Examination, or by means of a stepwise or combined approach involving more simple tests (CDT, TVF, Fototest, MIS, Memory Alteration Test, Eurotest). Associating an informant questionnaire (IQ) with the BCT is superior to the BCT alone for the detection of CI.The choice of instruments will depend on the patient's characteristics, the clinician's experience, and available time. The BCT and IQ must reinforce — but never substitute — clinical judgment, patient-doctor communication, and inter-professional dialogue. Palabras clave: Test cognitivos breves, Deterioro cognitivo, Detección, Cribado, Atención primaria, Atención especializada, Keywords: Brief cognitive tests, Cognitive impairment, Detection, Screening, Primary care, Specialised care

«Apuntes en Neurologia» es una iniciativa en la cual lideres de primera linea nacional e internacional, con amplio reconocimiento academico, se reunieron para sintetizar los aspectos clinicos mas destacables dentro de su area de interes y acercar las novedades en una lengua mas proxima. Entender los factores que afectan al inicio y progresion de cualquier enfermedad neurologica a traves de una revision es importante para el desarrollo de estrategias en pro de reducir la carga de estas enfermedades, y conocer los aspectos clinicos es esencial para poder resolver los problemas de la practica clinica diaria. Los datos aqui recogidos reflejan el peso de la evidencia y algunos de ellos anticipan un futuro prometedor en el tratamiento de estas enfermedades. Esta primera edicion se centra en trastornos neurologicos comunes paroxisticos como la migrana, la epilepsia y las alteraciones del sueno, y en trastornos neurodegenerativos como la enfermedad de Parkinson y el deterioro cognitivo. Se trata de patologias claramente diferentes, si bien algunas de ellas, como la migrana y la epilepsia, pueden compartir sintomatologia clinica. Los trastornos del sueno, por su parte, son manifestaciones importantes de enfermedades neurodegenerativas que, en ocasiones, son clinicamente evidentes mucho antes del inicio de otros sintomas neurologicos. Tras recordar la fisiopatologia y el diagnostico, la revision actual se centra en acercar los principales avances en cinco de las principales enfermedades neurologicas.

Apraxia is regarded as neurological disorder characterized by a loss of ability to execute and carry out skilled movements and gestures despite intact motor and sensory systems, coordination, and comprehension. As reflected in the specialized literature, there are currently few tests that provide a global evaluation of this syndrome. This research created and designed a test for the Evaluation of Upper Limb Apraxia (EULA), based on theoretical models of apraxia.A sample of 57 patients was selected with subjective cognitive manifestations (complaints of cognitive impairment) and 39 subjects without cognitive impairment. Both groups were given the EULA test as well as other tests. The structure of the EULA was verified with principal components factor analysis, and the reliability and validity of this instrument were also calculated.The factor analysis classified all of the items in the test in nine factors with an explained total variance of 69.91%. The high reliability of the test was reflected in a Cronbach's alpha of 0.929 and a Guttman split-half coefficient of 0.870. The construct validity was also satisfactory as shown in the significant correlation of six of the nine factors in the test with two other well-known apraxia subtests.The healthy subjects had a higher test score than the subjects with complaints of cognitive impairment, which confirmed the reliability and construct validity of the EULA.Creacion y diseño de un test para la evaluacion de la apraxia de los miembros superiores (EULA) basado en un modelo cognitivo: un estudio piloto.Introduccion. La apraxia es un trastorno neurologico caracterizado por la dificultad en la ejecucion de habilidades gestuales aprendidas a pesar de tener preservados los sistemas motores y sensoriales, la coordinacion y la comprension, asi como de una adecuada colaboracion. Actualmente, existen pocas herramientas validadas que evaluen este sindrome de manera global. En el presente estudio, se ha creado y diseñado un test para la evaluacion de la apraxia de los miembros superiores (EULA), basado en modelos teoricos. Sujetos y metodos. Se selecciono una poblacion de 57 pacientes con quejas subjetivas de deterioro cognitivo y 39 personas sin quejas ni deterioro cognitivo, a las cuales se les administro el test EULA, entre otros tests. Se realizo un analisis factorial de componentes principales y un calculo tanto de la fiabilidad como de la validez de dicho instrumento. Resultados. El analisis factorial agrupo en nueve factores todos los items de la prueba, con una varianza total explicada del 69,91%. El test ha mostrado una alta fiabilidad, con un alfa de Cronbach de 0,929 y un coeficiente de Guttman de 0,870 con el metodo de las dos mitades. El test tambien mostro tener una adecuada validez de constructo, al existir correlacion significativa entre seis factores del test y dos subtests de apraxia. Conclusiones. El test EULA, surgido de las propuestas de evaluacion a nivel teorico desarrolladas por diferentes autores, muestra una puntuacion superior en personas sanas respecto a personas con manifestaciones subjetivas de deterioro cognitivo, ademas de tener una alta fiabilidad y validez de constructo.

Dementia is a multi-etiologic syndrome characterized by multiple cognitive deficits but not always by the presence of cognitive impairment. Cognitive impairment is associated with multiple non-modifiable risk factors but few modifiable factors. Epidemiologic studies have shown an association between periodontitis, a potentially modifiable risk factor, and cognitive impairment. The objective of this study is to determine whether clinical periodontitis is associated with the diagnosis of cognitive impairment/dementia after controlling for known risk factors, including age, sex, and education level.A case-control study was conducted in Granada, Spain, in two groups of dentate individuals aged50 years: 1) cases with a firm diagnosis of mild cognitive impairment or dementia of any type or severity and 2) controls with no subjective memory loss complaints and a score30 in the Phototest cognitive test (screening test for cognitive impairment). Periodontitis was evaluated by measuring tooth loss, plaque and bleeding indexes, probing depths, and clinical attachment loss (AL).The study included 409 dentate adults, 180 with cognitive impairment and 229 without. A moderate and statistically significant association was observed between AL and cognitive impairment after controlling for age, sex, education level, oral hygiene habits, and hyperlipidemia (P = 0.049). No significant association was found between tooth loss and cognitive impairment.Periodontitis appears to be associated with cognitive impairment after controlling for confounders such as age, sex, and education level.

Phototest is a simple, easy and very brief test with theoretical advantages over available dementia screening tests in Spain. The objective of this study was to estimate the diagnostic accuracy of the Phototest for cognitive impairment and dementia and to compare it with that of the MMSE and the Clock Drawing Test (CDT) in an Argentine population. A phase II cross-sectional study of diagnostic tests evaluation was performed in a sample of 30 controls, 61 with amnestic mild cognitive impairment (a-MCI), and 56 with mild Alzheimer type dementia (DAT). The diagnostic accuracy (DA) was assessed in relation to the clinical diagnosis by calculating the area under the ROC curve (UAC), Sensitivity (Sn), and Specificity (Sp).The DA of the Phototest for a-MCI and DAT (0.93 and 0.97 [UAC]) was higher than that of the MMSE and the CDT. The cut-off points of 27/28 for DAT (Sn = 89.29 [78.1–96.0], Sp = 96.67 [82.8–99.9]) and 30/31 for a-MCI (Sn = 85.25 [73.8–93.0], Sp = 90.00 [73.5–97.9]) maximized the sum of Sn and Sp. Phototest correlates significantly with MMSE and CDT. The Phototest is an efficient instrument for the detection of mild dementia or MCI, with good accuracy and good correlation with tests measuring overall cognitive impairment. Fil: Russo, María Julieta. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Provincia de Buenos Aires. Hospital de Berisso; Argentina Fil: Iturry, Mónica. Gobierno de la Ciudad de Buenos Aires. Hospital "Dr. Abel Zubizarreta"; Argentina Fil: Sraka, María Alejandra. Provincia de Buenos Aires. Hospital de Berisso; Argentina Fil: Bartoloni, Leonardo. Gobierno de la Ciudad de Buenos Aires. Hospital "Dr. Abel Zubizarreta"; Argentina Fil: Carnero Pardo, Cristóbal. Hospital Universitario Virgen de las Nieves; España Fil: Allegri, Ricardo Francisco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

Resumen Objetivo Evaluar la utilidad diagnóstica (UD) del Mini-Mental (MMS) en la detección del deterioro cognitivo (DC) en Atención Primaria (AP) y determinar las mejores condiciones de aplicación para este fin. Diseño Análisis conjunto de 2 estudios de evaluación de pruebas diagnósticas prospectivos con selección consecutiva y sistemática, verificación completa y doble cegamiento, realizados en Madrid y Granada. Emplazamiento El MMS fue aplicado en AP y el diagnóstico de referencia en Atención Especializada. Participantes Se seleccionaron de forma consecutiva y sistemática sujetos con quejas o sospecha de DC atendidos en AP. Mediciones principales La UD del MMS se evaluó mediante el área bajo la curva ROC (AUC) y se consideró mejor punto de corte el que ofrecía la mayor tasa de aciertos diagnósticos (TAD) y el mayor índice kappa. Se analizó de forma independiente la UD para las puntuaciones directas (MMSd) y ajustadas por edad y nivel educativo (MMSa) Resultados En la muestra total de 360 sujetos (214 DC), la UD de MMSd fue significativamente superior a la de MMSa (0,84 ± 0,02 vs 0,82 ± 0,02, p ≤ 0,001). El rendimiento diagnóstico conseguido por el MMSd con el mejor punto de corte (22/23) fue discreto (TAD 0,77, kappa 0,52 ± 0,05), pero no fue mejorado por ningún punto de corte del MMSa. Conclusión El Mini-Mental tiene una UD discreta para la detección de DC en AP que no mejora con la corrección de las puntuaciones por edad y nivel educativo; el mejor punto de corte es 22/23, inferior al habitualmente recomendado.

Objectives. To study the utility of the Mini-Cog test for detection of patients with cognitive impairment (CI) in primary care (PC).Methods. We pooled data from two phase III studies conducted in Spain. Patients with complaints or suspicion of CI were consecutively recruited by PC physicians. The cognitive diagnosis was performed by an expert neurologist, after formal neuropsychological evaluation. The Mini-Cog score was calculatedpost hoc, and its diagnostic utility was evaluated and compared with the utility of the Mini-Mental State (MMS), the Clock Drawing Test (CDT), and the sum of the MMS and the CDT (MMS+CDT) using the area under the receiver operating characteristic curve (AUC). The best cut points were obtained on the basis of diagnostic accuracy (DA) and kappa index.Results. A total sample of 307 subjects (176 CI) was analyzed. The Mini-Cog displayed an AUC (±SE) of0.78±0.02, which was significantly inferior to the AUC of the CDT (0.84±0.02), the MMS (0.84±0.02), and theMMS+CDT(0.86±0.02). The best cut point of the Mini-Cog was 1/2 (sensitivity 0.60, specificity 0.90, DA 0.73, and kappa index0.48±0.05).Conclusions. The utility of the Mini-Cog for detection of CI in PC was very modest, clearly inferior to the MMS or the CDT. These results do not permit recommendation of the Mini-Cog in PC.

Clinical Trial, Phase III; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; BACKGROUND To assess and compare the effectiveness and costs of Phototest, Mini Mental State Examination (MMSE), and Memory Impairment Screen (MIS) to screen for dementia (DEM) and cognitive impairment (CI). METHODS A phase III study was conducted over one year in consecutive patients with suspicion of CI or DEM at four Primary Care (PC) centers. After undergoing all screening tests at the PC center, participants were extensively evaluated by researchers blinded to screening test results in a Cognitive-Behavioral Neurology Unit (CBNU). The gold standard diagnosis was established by consensus of expert neurologists. Effectiveness was assessed by the proportion of correct diagnoses (diagnostic accuracy [DA]) and by the kappa index of concordance between test results and gold standard diagnoses. Costs were based on public prices and hospital accounts. RESULTS The study included 140 subjects (48 with DEM, 37 with CI without DEM, and 55 without CI). The MIS could not be applied to 23 illiterate subjects (16.4%). For DEM, the maximum effectiveness of the MMSE was obtained with different cutoff points as a function of educational level [k = 0.31 (95% Confidence interval [95%CI], 0.19-0.43), DA = 0.60 (95%CI, 0.52-0.68)], and that of the MIS with a cutoff of 3/4 [k = 0.63 (95%CI, 0.48-0.78), DA = 0.83 (95%CI, 0.80-0.92)]. Effectiveness of the Phototest [k = 0.71 (95%CI, 0.59-0.83), DA = 0.87 (95%CI, 0.80-0.92)] was similar to that of the MIS and higher than that of the MMSE. Costs were higher with MMSE (275.9 ± 193.3€ [mean ± sd euros]) than with Phototest (208.2 ± 196.8€) or MIS (201.3 ± 193.4€), whose costs did not significantly differ. For CI, the effectiveness did not significantly differ between MIS [k = 0.59 (95%CI, 0.45-0.74), DA = 0.79 (95%CI, 0.64-0.97)] and Phototest [k = 0.58 (95%CI, 0.45-0.74), DA = 0.78 (95%CI, 0.64-0.95)] and was lowest for the MMSE [k = 0.27 (95%CI, 0.09-0.45), DA = 0.69 (95%CI, 0.56-0.84)]. Costs were higher for MMSE (393.4 ± 121.8€) than for Phototest (287.0 ± 197.4€) or MIS (300.1 ± 165.6€), whose costs did not significantly differ. CONCLUSION MMSE is not an effective instrument in our setting. For both DEM and CI, the Phototest and MIS are more effective and less costly, with no difference between them. However, MIS could not be applied to the appreciable percentage of our population who were illiterate. Yes

He leido con gran interes la revision de MoraSimon et al [1] acerca de la deteccion temprana del deterioro cognitivo, en la que tan acertadamente senalan la conveniencia de orientar la deteccion precoz al deterioro cognitivo mas que a la demencia, al tiempo que resaltan la dificultad de seleccionar un instrumento adecuado para este fin. Forzosamente, hay que coincidir con los autores en su recomendacion implicita de optar por instrumentos que evaluen multiples dominios (no solo memoria) y que esten libres, en la medida de lo posible, de la influencia cultural o educativa, asi como con la conveniencia del uso combinado de tests cognitivos con otros instrumentos. La larga, aunque no exhaustiva lista de tests revisada, se simplifica enormemente si se exigen unas condiciones minimas como estar validado en nuestro pais, haber sido evaluado para el diagnostico de deterioro cognitivo y tener una duracion razonable (< 10 min). Tan solo cuatro instrumentos validados en Espana cumplen los requisitos anteriores: Memory Impairment Screen (MIS), test de alteracion de memoria (T@M), Fototest y Eurotest [2]. Este ultimo se ha desarrollado en nuestro pais, ha sido validado para la deteccion de deterioro cognitivo, es aplicable a analfabetos y no esta influido por el nivel educativo, una cualidad con la que pocos instrumentos cuentan y que tanto valoran por los autores. Este instrumento cuenta, entre otros, con un estudio multicentrico [3] y un metaanalisis [4], y ha sido adaptado a otros sistemas monetarios donde tambien ha demostrado su utilidad [5]. Nuestro grupo ha llevado a cabo un estudio comparativo de la efectividad y el coste asociado al uso de los instrumentos arriba senalados y del test minimental de Folstein (Mini Mental State Examination), cuyos resultados pueden orientar y facilitar, en gran medida, la eleccion entre las distintas alternativas [6,7]. De forma resumida, los resultados mas relevantes son: – El MIS y el T@M solo evaluan memoria. – El MIS no se pudo aplicar al 16,4% de la muestra, que era analfabeta. – El test minimental de Folstein es con mucho la alternativa menos efectiva y mas cara. – El Fototest, T@M y Eurotest tienen la misma efectividad y coste. – El Fototest se aplica en menos de la mitad del tiempo (2,8 min) que el T@M (6,8 min), y el Eurotest (7,1 min).

Introduccion. El MIS (del ingles, Memory Impairment Screen) es muy util en la deteccion de la demencia, pero tiene el inconveniente de que evalua solo la memoria y no es aplicable a los analfabetos. Objetivo. Evaluar la utilidad del test de las fotos (TF), un nuevo test que combina tareas de memoria facilitada, denominacion y fluidez verbal. Pacientes y metodos. Es un estudio de fase I de evaluacion de pruebas diagnosticas en el que se evaluo a 60 sujetos mayores de 65 anos (30 con demencia en estadio leve y 30 sin demencia). Se estudiaron sus variables sociodemograficas y los resultados en el minimental (MMSE), el SPMSQ (del ingles Short Portable Mental Status Questionnaire), el test del reloj (TR) y el TF. Para el estudio estadistico se compararon entre grupos las variables sociodemograficas y los resultados en los test, se determinaron los parametros de utilidad diagnostica, las areas bajo la curva ROC, con sus respectivos intervalos de confianza del 95% y se realizo un estudio de regresion lineal con estrategia ?paso a paso?. Resultados. Los grupos no diferian en edad, sexo, nivel educativo ni grado de alfabetizacion. El TF tiene una sensibilidad de 0,93 (0,76-0,99) y una especificidad de 0,8 (0,7-0,9), similar o superior a las del SPMSQ, el MMSE y el TR y sus resultados no estan influidos por el nivel educativo ni la alfabetizacion. Conclusion. El TF, por sus caracteristicas psicometricas y de aplicabilidad, es un excelente instrumento para el cribado de demencia.

Summary. Introduction. The changeover to the new currency has meant that the Money test, a screening test for dementia with a number of advantages over those currently available, is now of no use. Aims. Our aim was to perform a preliminary evaluation of the Eurotest, which is a version of the Money test adapted to the new currency system. Subjects and methods. Design: phase I, diagnostic evaluation (convenience sampling; pre-test prevalence 50%). Subjects: > 65 years with no sensory deficit; 30 with mi dementia and 30 without dementia. Method: evaluation of socio-demographic variables and of mini-mental performance (MMSE), Pfeiffer’s test (SPMSQ), the seven-minute test (and Eurotest. Statistical study: comparison between groups using t test an d chi squared, depending on the variables; determination of diagnostically useful parameters and ROC curves, with their respectiv e 95% confidence intervals; linear regression study with a ‘step-by-step’ strategy. Results. The groups did not differ as regards age, sex, level of schooling, degree of literacy, employment and knowledge of money systems. The Eurotest has a sensitivity of 0.93 (0.760.99) and a specificity of 0.87 (0.68-0.96), which is similar to that of the MMSE and the 7MT. The Eurotest (6.77±1.65 min) takes less time than the 7MT (8.87±1.81 min) and is not modified by the subject’s clinical situation. The level of schooling does not affect the results of the Eurotest. Conclusions. The Eurotest is simple, quick, valid, useful and is unaffected by the level of schooling, which are features that make it a valid alternative to the tests currently available. [REV NEUROL 2004; 38: 201-9]