ABSTRACT
Resumen El progresivo incremento de la enfermedad de Alzheimer ha generado el interés en su detección temprana, siendo los test de cribado cognitivo una herramienta útil, sin embargo, se necesita que los mismos estén culturalmente adaptados, sean objetivos y confiables. En el Perú, esta necesidad es mayor ya que el nivel educativo de la población de la tercera edad es mayoritariamente bajo. La presente investigación tiene como objetivo conocer la sensibilidad y especificidad del FOTOTEST frente al MMSE para el cribado/detección de deterioro cognitivo, analizando la relación de estos test cognitivos frente a uno de actividad funcional. Se evaluaron a 107 adultos mayores, con un rango de edad entre 60 y 89 años. Se utilizó la escala de Yesavage para la depresión geriátrica, el cuestionario de actividades funcionales de Pfeffer, MMSE y FOTOTEST. El análisis efectuado a través de la prueba de Pearson, evidencia una correlación significativa positiva entre el MMSE/FOTOTEST (Pearson 0.386, p<0.003), mientras que solo el MMSE mostró una correlación significativa negativa con el PFAQ (Pearson -0.320, p<0.013). Sin embargo, el FOTOTEST no mostró una correlación significativa con el PFAQ (Pearson -0.067, p<0.613). Adicionalmente, se calcula el porcentaje de efectividad y especificidad estimada para el FOTOTEST siendo de 100.00% y 92.68% respectivamente, superior al del MMSE, cuyo porcentaje estimado de efectividad fue de 83.33%, y especificidad 34.14%. Se concluye que el FOTOTEST sería una prueba más útil para la detección del deterioro cognitivo.
Abstract The progressive increase of Alzheimer's disease has generated interest in its early detection with cognitive screening tests being a useful tool, however, they need to be culturally adapted, objective and reliable. In Peru, this need is greater since the educational level of the elderly population is mostly low. The aim of the present study is to know the estimate sensitivity and specificity of FOTOTEST against MMSE for the screening/detection of cognitive impairment, analyzing the relationship of these cognitive tests with one of functional activity. 107 elderly people, aged 60-89 years, were evaluated. The Yesavage scale for geriatric depression was used, the functional activities questionnaire of Pfeffer, MMSE, and FOTOTEST. Pearson's analysis showed a significant positive correlation between MMSE/FOTOTEST (Pearson 0.386, p <0.003), whereas only MMSE showed a significant negative correlation with PFAQ (Pearson -0.320, p <0.013). However, FOTOTEST did not show a significant correlation with PFAQ (Pearson -0.067, p <0.613). In addition, the percentage of effectiveness and specificity estimated for FOTOTEST was 100.00% and 92.68%, respectively, higher than the MMSE, with an estimated percentage of effectiveness being 83.33%, and specificity of 34.14%. We conclude that FOTOTEST would be a more useful test for the detection of cognitive impairment than MMSE
ABSTRACT
Multiple Sclerosis (MS) is one of the most common neurological disorders. Cognitive dysfunction is considered a clinical marker of MS, where approximately half of patients with MS have cognitive impairment. Objective : The Phototest (PT) is a brief cognitive test with high diagnostic sensitivity, accuracy and cost-effectiveness for detecting cognitive deterioration. Our aim was to test the utility of the PT as a neurocognitive screening instrument for MS. Methods : The study enrolled 30 patients with different types of MS from an outpatient clinic as well as 19 healthy participants. In conjunction with the PT, the Montreal Cognitive Assessment (MoCA), Barthel Index (BI), Expanded Disability Status Scale (EDSS), and Fatigue Severity Scale (FSS) were administered. Results : The MS group obtained significantly lower results on all domains of the PT, except for the naming task. The PT showed good concurrent validity with the MoCA. In direct comparison to the MoCA, PT showed a greater area under the curve and higher levels of sensitivity and specificity for MS neurocognitive impairments. A cut-off score of 31 on the Phototest was associated with sensitivity of 100% and specificity of 76.7%. Conclusion : The PT is a valid, specific, sensitive and brief test that is not dependent on motor functions. The instrument could be an option for neurocognitive screening in MS, especially in identifying cases for further neuropsychological assessment and intervention.
A Esclerose Múltipla (EM) é das doenças neurológicas mais comuns. A disfunção cognitiva consiste num marcador clínico da EM, cerca de metade dos pacientes apresentam comprometimento cognitivo. Objetivo : O Fototest (FT) é um teste breve, sensível, específico e com boa relação custo-eficácia na deteção de deterioração cognitiva. Pretendemos testar a validade do FT como um instrumento de screening neurocognitivo na EM. Métodos : O estudo envolveu uma amostra de 30 doentes com diferentes tipos de EM de uma clínica de tratamento ambulatório e 19 participantes saudáveis. Em conjunto com o FT, foram aplicados o Montreal Cognitive Assessment (MoCA), o Índice de Barthel (IB), a Expanded Disability Status Scale (EDSS) e a Escala de Severidade de Fadiga (FSS). Resultados : O grupo EM obteve resultados significativamente inferiores em todos os domínios do FT, excepto na tarefa de nomeação. O FT apresenta boa validade concorrente com o MoCa. Na comparação direta com o MoCa, o FT revelou uma área sob a curva superior e níveis de sensibilidade e especificidade para os défices cognitivos na EM superiores. Ao ponto de corte de 31 no FT correspondem valores de sensibilidade de 100% e especificidade de 76,7%. Conclusão : O FT é um teste válido, específico, sensível e breve, não dependente das funções motoras. Pode ser uma opção para o screening neurocognitivo na EM, especialmente na identificação de casos para posterior avaliação neuropsicológica e intervenção.