Asociación entre los niveles de vitamina B12 y el deterioro cognitivo en personas mayores / Association between vitamin B12 levels and cognitive impairment in older adults

Resumen Introducción: Aún es controversial si la deficiencia de vitamina B12 se asocia a alteraciones cognitivas. Objetivo: Conocer la asociación entre los niveles séricos de vitamina B12 y el desempeño cognitivo. Métodos: Se incluyeron 241 personas ≥ 60 años con medición de niveles séricos de vitamina B12. Se realizó evaluación física y cognitiva y se formaron tres grupos: cognición normal (CN), deterioro cognitivo leve (DCL) y demencia. Los niveles de vitamina B12 se clasificaron en suficiencia (> 400 pg/mL), deficiencia subclínica (201-400 pg/mL) y deficiencia absoluta (≤ 200 pg/mL). Se realizó análisis de regresión lineal multivariado para evaluar la asociación entre función cognitiva y niveles de vitamina B12 después de controlar las variables confusoras. Resultados: La media de edad fue 81.4 ± 8.0 años; 68 % fue del sexo femenino; 17.8 y 39.8 % presentaron deficiencia absoluta y subclínica de vitamina B12; 80 individuos (33 %) cumplieron los criterios de DCL y 70 (29 %), de demencia. Después de ajustar por edad, sexo y escolaridad, los sujetos con DCL y demencia tuvieron niveles más bajos de vitamina B12 comparados con aquellos con CN (p = 0.019). Conclusiones: Se observó asociación estadísticamente significativa entre el desempeño cognitivo global y los niveles bajos de vitamina B12.

Abstract Introduction: Whether vitamin B12 deficiency is associated with cognitive impairment remains controversial. Objective: To determine the association between vitamin B12 serum levels and cognitive performance. Methods: Two-hundred and forty-one adults aged ≥ 60 years who had serum vitamin B12 serum levels measurement were included. Physical and cognitive evaluation was carried out, and three groups were formed: normal cognition (NC), mild cognitive impairment (MCI) and dementia. Vitamin B12 levels were classified as sufficiency (> 400 pg/mL), subclinical deficiency (201-400 pg/mL), and absolute deficiency (≤ 200 pg/mL). Multivariate linear regression analysis was used to evaluate the association between cognitive function and vitamin B12 levels after controlling for confounding variables. Results: Mean age was 81.4 ± 8.0 years; 68% were females; 17.8 % and 39.8% had absolute and subclinical vitamin B12 deficiency, respectively; 80 individuals (33%) met the criteria for MCI, and 70 (29%), for dementia. Those with MCI and dementia had lower vitamin B12 levels in comparison with those with NC after adjusting for age, gender and educational level (p = 0.019). Conclusions: A statistically significant association was observed between global cognitive performance and levels of vitamin B12.

Association of loneliness, social isolation, and daily cognitive function in Mexican older adults living in community during the first wave of COVID-19 pandemic / Asociación del aislamiento social, soledad y la función cognitiva cotidiana en adultos mayores mexicanos de la comunidad durante la primera ola del COVID-19

Abstract Introduction Loneliness and social isolation are known risk factors for cognitive decline; their effect in older adults (OA) after COVID-19 lockdown is emerging. Objective To establish an association between loneliness and social isolation, with daily cognitive function in Mexican OA during the first wave of the COVID-19 pandemic. Method Cross-sectional study, derived from the cohort "The impact of COVID 19 on well-being, cognition, and discrimination among older adults in the United States and Latin America", which included 308 OA recruited between March-August 2020 whose daily cognitive function were determined with the Everyday Cognition Scale (E-Cog) as dichotomized score (cut point: 1.31 for normal cognition). Loneliness and social isolation were binomial variables. Results The mean age was 65.4 ± 7.9 years, 75.7% were women. The mean continuous E-Cog score was 57.4 (SD = ± 19.1), 49.1% had a score < 1.31 (normal cognition), while 50.9% had a higher score (cognitive impairment). Eighty four percent of participants reported loneliness, 79.9% reported social isolation. Multivariate regression model showed a negative and statistically significant association between social isolation and loneliness and E-Cog, adjusted by age, sex and education level (β = -.046, 95% CI = [-.8, -.013], p = .007; β = -.16, 95% CI = [-.08, -.018], p = .003), and a positive association with subjective memory complaint (β = .81, 95% CI = [-.16, -.11], p = < .001). Discussion and conclusion These data suggest the need for increased vigilance of those who have loneliness and social isolation due to its potential deleterious effect on cognitive function.

Resumen Introducción La soledad y el aislamiento social son factores de riesgo conocidos para el deterioro cognitivo; su efecto en las personas mayores (PM) después del confinamiento por COVID-19 está emergiendo. Objetivo Establecer una asociación entre la soledad y el aislamiento social, con la función cognitiva diaria en PM mexicanas durante la primera ola de la pandemia por COVID-19. Método Estudio transversal derivado de la cohorte "The impact of COVID 19 on well-being, cognition, and discrimination among older adults in the United States and Latin America", incluyó 308 AM reclutados de marzo-agosto 2020, la función cognitiva diaria fue evaluada con Everyday Cognition Scale (E-Cog) con un punto de corte 1.31 (cognición normal); la soledad y el aislamiento social fueron variables binomiales. Resultados La media de edad fue 65.4 ± 7.9 años, 75.7% mujeres. E-Cog promedio fue 57.4 (DE = ± 19.1), 49.1 % tenía una puntuación < 1.31 (cognición normal), 50.9% > 1.31 (deterioro cognitivo). Ochenta y cuatro por ciento de los participantes reportaron soledad, 79.9% aislamiento social. El modelo de regresión multivariado mostró una asociación negativa y estadísticamente significativa entre aislamiento social y soledad con E-Cog (β = -.046, IC 95% = [-.8, -.013], p = .007; β = -.16, IC 95% = [-.08, -.018], p = .003), y una asociación positiva con queja de memoria subjetiva (β = .81, IC 95% = [-.16, -.11], p = < .001) ajustado a edad, sexo y escolaridad. Discusión y conclusión Estos datos sugieren la necesidad de una mayor vigilancia de quienes presentan soledad y aislamiento social debido a su potencial efecto deletéreo sobre la función cognitiva.

Cross-cultural adaptation of the everyday cognition scale (M-ECog) in older Mexican adults with cognitive impairment / Adaptação transcultural da escala de cognição cotidiana (M-ECog) em idosos mexicanos com comprometimento cognitivo

Abstract The Everyday Cognition (ECog) scale was created to evaluate the functional abilities of older adults across a wide range of abilities between normal aging and dementia. ECog screens cognitive alterations such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This early recognition is done by the measurement of the ability to perform the activities of daily living (ADLs). Objective: To establish the cross-cultural adaptation, validity, and reliability of the ECog Mexican version (M-ECog) in participants with: SCD, MCI, and dementia coming from a memory clinic. Methods: There were 200 patients and their respective informants in a memory clinic of a third level hospital in Mexico City. Four groups were studied: 50 cognitively healthy (CH), 50 SCD, 50 MCI, and 50 dementia. The clinical evaluation included: sociodemographic and health characteristics, cognitive status by the Mini-Mental State Evaluation (MMSE) and Montreal Cognitive Evaluation Spanish version (MoCA-E), and caregiver information (informants) about the difficulty in ADLs as well as the ECog Spanish version (M-ECog). Results: The M-ECog was significantly correlated with MMSE, MoCA-E, and ADLs. It showed the ability to discriminate the different cognitive declines (Cronbach's alpha 0.881). The intra-class correlation coefficient was 0.877 (95% confidence interval — CI, 0.850-0.902; p<0.001). The patient's group area under curve (AUC) of M-ECog for SCD was 0.70 (95%CI 0.58-0.82, p<0.005), for MCI it was 0.94 (95%CI 0.89-0.99, p<0.001) and for dementia 0.86 (95%CI 0.79-0.92, p<0.001). Conclusion: The M-ECog scale proves to be valid and reliable for measuring everyday abilities mediated by cognition. It is self-applicable without requiring extensive prior formation. It is useful to screen for SCD and MCI in older Mexican adults.

RESUMO A escala Cognição Cotidiana (ECog) foi criada para avaliar as habilidades funcionais de idosos em uma ampla gama de habilidades entre o envelhecimento normal e a demência. O ECog rastreia alterações cognitivas como declínio cognitivo subjetivo (DCS) e comprometimento cognitivo leve (CCL). Esse reconhecimento precoce é feito pela mensuração da capacidade de realizar as atividades de vida diária (AVD). Objetivo: Estabelecer a adaptação transcultural, validade e confiabilidade da versão mexicana do ECog (M-ECog) em participantes com: SCD, MCI e demência provenientes de uma clínica de memória. Métodos: Foram 200 pacientes e seus respectivos informantes em uma clínica de memória de um hospital de terceiro nível na Cidade do México. Quatro grupos foram estudados: 50 cognitivamente saudáveis (CH), 50 SCD, 50 MCI e 50 com demência. A avaliação clínica incluiu: características sociodemográficas e de saúde, estado cognitivo pelo Mini-Mental State Evaluation (MMSE) e Montreal Cognitive Evaluation versão em espanhol (MoCA-E), bem como informações do cuidador (informantes) sobre a dificuldade nas AVD e o ECog versão em espanhol (M-ECog). Resultados: O M-ECog foi significativamente correlacionado com MMSE, MoCA-E e AVD. Mostrou capacidade de discriminar os diferentes declínios cognitivos (alfa de Cronbach 0,881). O coeficiente de correlação intraclasse foi de 0,877 (intervalo de confiança de 95% — IC95%, 0,850-0,902; p<0,001). A AUC do grupo do paciente de M-ECog para SCD foi de 0,70 (IC95% 0,58-0,82, p<0,005), para MCI foi de 0,94 (IC95% 0,89-0,99, p<0,001) e para demência foi de 0,86 (IC95% 0,79-0,92, p<0,001). Conclusão: A escala M-ECog mostra-se válida e confiável para medir habilidades cotidianas mediadas pela cognição. É autoaplicável sem exigir extensa formação prévia. É útil para rastrear MSC e MCI em adultos mexicanos mais velhos.

Tratamiento ortodóncico-quirúrgico de pacientes con asimetría facial / Orthodontic-surgical treatment of patients with facial asymmetry

Introducción: la asimetría facial es una condición notoria en el tercio inferior de la facie del sujeto y entre los tercios medio y superior, en este último será menos evidente esta condición, de tal manera que podría considerarse como una de las molestias de mayor incidencia en pacientes con necesidades o no de terapia or- todóncica. Objetivo: evaluar mediante una revisión de la literatura los tratamientos ortodóncico-quirúrgicos de pacientes con asimetría facial. Material y métodos: la literatura se seleccionó mediante una búsqueda en las bases de datos electrónicas: PubMed, Scopus, Web of Science. Las palabras clave utilizadas fueron: facial asymmetry, asymmetry, surgical treatment, surgical orthodontic treatment. La búsqueda se restringió a artículos en inglés publicados del año 2011 al 2021. Resultados: después de aplicar los criterios de inclusión y exclusión en total se obtuvieron y revisaron 27 artículos. Se realizó la revisión de literatura del tratamiento ortodóncico-quirúrgico en pacientes con asimetría facial. Conclusión: es preciso el abordaje ortodóntico quirúrgico para la corrección de la asimetría facial, del protocolo dependerá la situación clínica y la elección de tratamiento ortodóntico quirúrgico, lo que brindará mejoras significativas en la simetría facial (AU)

Introduction: facial asymmetry, is a notorious condition in the lower third of the subject's facie and between the middle and upper thirds, in the latter this condition will be less evident; in such a way, it could be considered as one of the discomforts of greater incidence in patients with needs or not of orthodontic therapy. Objective: to evaluate by means of a literature review the orthodontic-surgical treatment of patients with facial asymmetry. Material and methods: the literature was selected through a search in the following electronic databases: PubMed, Scopus, Web of Science. The keywords used were: facial asymmetry, asymmetry, surgical treatment, surgical orthodontic treatment. The search was restricted to articles in English published from 2011 to 2021. Results: after applying the inclusion and exclusion criteria, a total of 27 articles were obtained and reviewed. The literature review of orthodontic-surgical treatment in patients with facial asymmetry was performed. Conclusion: surgical orthodontic approach is necessary for the correction of facial asymmetry, the protocol will depend on the clinical situation, the choice of surgical orthodontic treatment, which will give significant improvements in facial symmetry (AU)

Prevention, diagnosis, and treatment of delirium in older adults with COVID-19. Literature review / Prevención, diagnóstico y tratamiento del delirium en adultos mayores con COVID-19. Revisión de la literatura

Abstract Background COVID-19 affects several systems in the body, including the central nervous system (CNS), expressed in the form of headaches, hyposmia, cerebrovascular disease, and neuropathy. Older Adults (OA) are vulnerable to this infection, and may also present delirium, which may be the result of the virus directly affecting the CNS or of systemic inflammation during infection. Objective To determine the clinical characteristics, risk factors, pathophysiology, treatment measures, and prevention of delirium associated with COVID-19 from a review of the literature in times of the SARS-CoV-2 pandemic. Method A search was conducted in PubMed, SciELO, UpToDate, and Medscape using keywords in English and Spanish. Results Seventy-two articles were reviewed. We analyzed inclusion and exclusion criteria and 43 articles with relevant information for the narrative description of the review were selected. Twenty to thirty per cent of the COVID-19 patients will present or develop delirium, or changes in mental status during their hospitalization, with rates of 60% to 70% in severe illness. The exact mechanisms are likely to be multifactorial. There is a worrying lack of attention to the implications of identifying and managing delirium in the response to this pandemic. Discussion and conclusion Delirium is a frequent neurological manifestation in OA with COVID-19 and requires early identification, as well as the implementation of non-pharmacological and pharmacological treatment strategies, which may reduce the associated morbidity and mortality in this age group.

Resumen Antecedentes La COVID-19 afecta múltiples sistemas del organismo. Uno de ellos es el sistema nervioso central (SNC), cuya afección se manifiesta con cefalea, hiposmia, enfermedad vascular cerebral y neuropatía. Además de que los adultos mayores (AM) son vulnerables a esta infección, pueden presentar delirium, el cual puede ser resultado de una afección directa del virus al SNC o resultado de la inflamación sistémica durante la infección. Objetivo Conocer las características clínicas, factores de riesgo, fisiopatología, medidas de tratamiento y prevención del delirium asociados a COVID-19 a partir de la revisión de la literatura en tiempos de la pandemia por SARS-CoV-2. Método Se realizó una búsqueda en PubMed, SciELO, UpToDate y Medscape utilizando palabras clave en inglés y español. Resultados Se revisaron 72 artículos, se analizaron criterios de inclusión y exclusión y se seleccionaron 43 artículos con información relevante para la descripción narrativa de la revisión. El 20-30% de los pacientes con COVID-19 presentarán o desarrollarán delirium, o cambios en su estado mental durante el curso de su hospitalización, con tasas del 60-70% en enfermedad grave. Es probable que los mecanismos exactos sean multifactoriales. Existe una preocupante falta de atención a las implicaciones de la identificación y el manejo del delirium en la respuesta a esta pandemia. Discusión y conclusión El delirium es una manifestación neurológica frecuente en los AM con COVID-19 y requiere su identificación temprana, así como la implementación de estrategias de tratamiento no farmacológico y farmacológico, lo que puede disminuir la morbimortalidad asociada en este grupo etario.

Association of vitamin d with mild cognitive impairment and alzheimer's dementia in older mexican adults

ABSTRACT Background It has been proposed that Vitamin D helps reduce the accumulation of cerebral β-amyloid-42 by innate immune stimulation and phagocytosis activation. An association between low Vitamin D levels and Alzheimer’s dementia (AD) has been established. We determined the association between Vitamin D, mild cognitive impairment (MCI), and AD in older Mexican adults (> 65 years) Methods Cross-sectional study conducted at the memory clinic in a tertiary-level hospital in Mexico City. We evaluated subjects with MCI, AD, and normal cognition (NC) with available serum Vitamin D [25(OH)D] levels (past 6 months). Three categories were assigned according to 25(OH)D levels: sufficiency (> 30 ng/mL), insufficiency (21-29 ng/mL), and deficiency (≤ 20 ng/mL). Descriptive statistics, means and standard deviations were used. Logistic regression analyses adjusted by age, sex, and educational level were performed Results We evaluated 208 patients. Mean age was 79 ± 1 year, 65% (n = 136) were female; and mean educational level was 6.7 ± 2.3 years. Thirty-one subjects (14%) had NC; 42% (n = 88) had MCI; and 43% (n = 89) had AD. Prevalence of Vitamin D deficiency was 54%, more frequent in the AD group (64%) followed by the MCI (59%) and NC (13%) (p < 0.001) groups. In the multivariate logistic regression analysis, Vitamin D deficiency was associated with MCI (HR 25.02 [confidence interval 95% 4.48-139]; p < 0.001) and AD (HR 41.7 [5.76-301]; p < 0.001) after adjusting for confounders Conclusions Serum Vitamin D deficiency was associated with MCI and dementia; low levels produced a greater effect over executive functions.

Spanish validation and cultural adaptation of the Five-Word Test for the detection of the neurocognitive disorder in older adults / Adaptación cultural y validación al español de la Prueba de Cinco Palabras para detectar el trastorno neurocognitivo en adultos mayores

Abstract Introduction "Episodic" memory problems are common in people with cognitive impairment due to Alzheimer's disease and related disorders. Dubois et al. developed the Five-Word Test (5WT) to evaluate episodic memory, which has proved to be an easy and valid test for identifying cognitive disorders. However, its validation and cultural adaptation from French to Spanish has not been undertaken and its usefulness in Mexican population is unknown. Objective Validation and cultural adaptation of the 5WT for screening minor and major neurocognitive disorder (ND) in Mexican older adults with probable Alzheimer's disease. Method Two hundred and fifteen participants (70 cognitively healthy subjects, 73 with minor ND and 72 with major ND were included). The cognitive status (gold standard) was determined using current clinical criteria and neuropsychological evaluation. The Spearman coefficient, ROC curve, and multinomial logistic regression models were used to determine the concurrent validity of the 5WT. Results The correlation between the 5WT and the Mini-Mental State Exam (MMSE) was .58, whereas for the clock face test it was -.37 (p < .001). The area under the 5WT curve was .97 (95% CI [.94, .99]), with a cut-off point of ≤ 16/20 for the diagnosis of major ND (89% sensitivity, 98% specificity) and .77 (95% CI [.70, .85]) for minor ND with a cut-off point of ≤ 18/20 (66% sensitivity, 77% specificity). Discussion and conclusion Since the 5WT is a simple, valid instrument for the identification of neurocognitive disorders like Alzheimer's disease, it could be a practical screening test.

Resumen Introducción Los problemas de la memoria "episódica" son comunes en las personas con deterioro cognitivo tipo Alzheimer. Dubois et al. desarrollaron la Prueba de Cinco Palabras (P5P) para evaluar la memoria episódica, la cual ha demostrado ser sencilla y válida para identificar trastornos cognitivos. Sin embargo, su validación y adaptación cultural del francés al español no se ha realizado y se desconoce su utilidad en población mexicana. Objetivo Validación y adaptación cultural de la P5P para el tamizaje del trastorno neurocognitivo (TNC) menor y mayor en adultos mayores mexicanos con probable enfermedad de Alzheimer. Método Participaron 215 participantes (70 cognitivamente sanos, 73 con TNC menor y 72 con TNC mayor. El estado cognitivo (estándar de oro) se determinó mediante los criterios clínicos vigentes y de evaluación neuropsicológica. El coeficiente de Spearman, la curva ROC y modelos de regresión logística multinomial se utilizaron para determinar la validez concurrente de la P5P. Resultados La correlación entre la P5P y el MMSE fue de .58, mientras que para la prueba de reloj fue de -.37 (p < .001). El área bajo la curva de la P5P fue .97 (IC 95% [.94, .99]), con un punto de corte ≤ 16/20 para el diagnóstico del TNC mayor (sensibilidad: 89%, especificidad: 98%) y de .77 (IC 95% [.70, .85]) para el TNC menor con un punto de corte ≤ 18/20 (sensibilidad: 66%, especificidad: 77%). Discusión y conclusión La P5P es un instrumento válido y simple para identificar de trastornos neurocognitivos de tipo Alzheimer por lo que podría ser una prueba práctica para uso en el tamizaje.

Validez y confiabilidad del MoCA (Montreal Cognitive Assessment) para el tamizaje del deterioro cognoscitivo en México / Validity and Reliability of the Spanish Version of the Montreal Cognitive Assessment (MoCA) for the Detection of Cognitive Impairment in Mexico

resumen Objetivo: Establecer la validez y confiabilidad del Montreal Evaluación Cognitiva en Español (MoCA-E) para identificar deterioro cognitivo leve (DCL) y demencia en adultos mayores mexicanos. Material y métodos: Se incluyó a 168 participantes en una clínica de memoria de la ciudad de México, en 3 grupos: 59 cognitivamente sanos (GCS), 52 con DCL (criterios del DSM-V) y 57 con demencia (criterios NINCDS-ADRDA). Se aplicó el MoCA-E y el Mini-Mental State Evaluation al inicio y en los últimos meses, para establecer la confiabilidad intraobservador. Se construyeron curvas ROC y un modelo de regresión multinomial para evaluar el efecto de la edad y la escolaridad en el desempeño del MOCA-E. Resultados: El promedio de edad de los participantes era 76 ± 8,1 años; la tasa de escolaridad, 10,7 ± 5,2. Las puntuaciones de MoCA-E por grupo fueron: GCS, 27,3 ± 1,9; DCL, 22,9 ± 2,9, y demencia, 13,7 ± 4,9 (p< 0,001). La confiabilidad del MoCA-E fue 0,89 con un coeficiente de correlación intraclase de 0,955. La sensibilidad fue del 80% y la especificidad, del 75% con el punto de corte de 26 puntos para DCL (área bajo la curva = 0,886; p< 0,001). Para demencia, la sensibilidad fue del 98% y la especificidad, del 93% con el punto de corte de 24 puntos (área bajo la curva = 0,998; p< 0,001). La regresión multinomial no mostró asociación con la escolaridad y la edad tanto para DCL como para demencia. Conclusiones: El MoCA-E es un instrumento con validez y confiabilidad para el cribado de DCL y demencia en la población mexicana, aun después de ajustar por edad y escolaridad.

abstract Objective: To establish the validity and reliability of the Montreal Cognitive Assessment in Spanish (MoCA-S) to identify mild cognitive impairment (MCI) and dementia in the Mexican elderly population. Material and methods: 168 participants from a memory clinic in Mexico City were enrolled and divided into 3 groups: 59 cognitively healthy (CHG), 52 with mild cognitive impairment (MCI) (DSM-5 criteria) and 57 with dementia (NINCDS-ADRDA criteria). The MoCA-S and Mini-Mental State Evaluation (MMSE) were applied at baseline and during the last months to establish intra-observer reliability. ROC curves and a multinomial regression model were constructed to evaluate the effect of age and education on MoCA-S performance. Results: The mean age of the participants was 76 ± 8.1 years and the education rate was 10.7 ± 5.2. The MoCA-S scores by group were: CHG, 27.3 ± 1.9; MCI, 22.9 ± 2.9; and dementia, 13.7 ± 4.9(p< 0.001). The reliability of the MoCA-S was 0.89 and the intraclass correlation coefficient was 0.955. Sensitivity was 80% and specificity was 75%, with a cut-off point of 26 points for MCI (area under the curve, 0.886; p< 0.001). For the dementia group, the sensitivity was 98% and specificity was 93%, with a cut-off point of 24 points (area under the curve, 0.998; p< 0.001). The multinomial regression showed no association with education and age for both the MCI and dementia groups. Conclusions: The MoCA-S is a valid and reliable instrument for MCI and dementia screening in the Mexican population, even after adjusting for age and education.

Validation of the Clock Drawing Test Scoring Method in older adults with neurocognitive disorder / Validación del método de calificación del Test del Dibujo del Reloj en adultos mayores con trastorno neurocognitivo

Abstract: Introduction: The Clock Drawing Test (CDT) is a widely used instrument for identifying neurocognitive disorders (NCDs) in older adults. However, there is insufficient evidence to determine the best scoring method, since current quantitative methods involve the assignment of numerical values, while qualitative ones do not allow for objectivity in the diagnosis. Parsey & Schmitter-Edgecombe (2011) proposed a scoring scheme which, in addition to providing a score of the patient's performance, permits error analysis, thereby making it possible to identify potential underlying cognitive difficulties. Objective: The purpose of this study was to validate the CDT scoring scheme proposed by Parsey & Schmitter-Edgecombe (2011) for screening for NCDs in Mexican older adults. Method: There were 167 participants: 58 cognitively healthy subjects (CH), 52 with mild neurocognitive disorder (mild-NCD), and 57 with major neurocognitive disorder (major-NCD).The CDT scoring method was compared with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment in Spanish (MoCA-S). Inter- and intra-observer reliability and construct validity were determined and the sensitivity and specificity of this method were calculated. Results: The X - age was 75 years (SD ± 8 years) and the X - educational attainment was 10.7 years (SD ± 5.2 years). Internal reliability was .750, with an intraclass correlation coefficient of .774. The cut-off point for the CDT in mild-NCD was 14 points (sensitivity: 40%, specificity: 70%) and 12 points for major-NCD (sensitivity: 90%, specificity: 95%).The most frequent errors in the CDT were: graphic, conceptual, spatial, and/or planning difficulties. Discussion and conclusion: This method makes it possibly to quickly and easily explore the cognitive status of the patient. It contains ideal psychometric properties for the detection of patients with major-NCD, in addition to offering the possibility of analyzing performance errors and underlying cognitive difficulties.

Resumen: Introducción: El Test del Dibujo del Reloj (TDR) es un instrumento ampliamente utilizado para identificar trastornos neurocognitivos (TNC) en adultos mayores. Sin embargo, no existe suficiente evidencia para determinar el mejor método para calificarlo, ya que los métodos cuantitativos actuales se abocan a la asignación de valores numéricos, mientras que los cualitativos no permiten objetividad en el diagnóstico. Parsey y Schmitter-Edgecombe (2011) propusieron un método de calificación que, además de proporcionar un puntaje de la ejecución del paciente, permite el análisis de los errores y, con ello, la identificación de las potenciales dificultades cognitivas subyacentes. Objetivo: El objetivo de este estudio fue validar el método de calificación del TDR propuesto por Parsey y Schmitter-Edgecombe (2011) para el tamizaje del TNC en adultos mayores mexicanos. Método: Se contó con 167 participantes: 58 cognitivamente sanos (CS), 52 con trastorno neurocognitivo leve (TNC-leve) y 57 con trastorno neurocognitivo mayor (TNC-mayor). El método de calificación del TDR se comparó con el Examen Mínimo del Estado Mental (MMSE) y la Evaluación Cognitiva de Montreal en español (MoCA-E). Se determinó la confiabilidad inter e intra-observador y la validez de constructo, y se calcularon la sensibilidad y la especificidad de este método. Resultados: La X - de edad fue de 75 años (DE ± 8 años) y la X - de escolaridad fue de 10.7 años (DE ± 5.2 años). La confiabilidad interna fue de .750, con un coeficiente de correlación intraclase de .774. El punto de corte para el TDR en TNC-leve fue de 14 puntos (sensibilidad: 40%, especificidad: 70%) y 12 puntos para TNC-mayor (sensibilidad: 90%, especificidad: 95%). Los errores más frecuentes en el TDR fueron: dificultades gráficas, conceptuales y espaciales, y/o de planeación. Discusión y conclusión: Este método permite explorar breve y ágilmente el estado cognitivo del paciente y posee propiedades psicométricas ideales para la detección de pacientes con TNC-mayor, además de ofrecer la posibilidad de analizar los errores que presentan en el desempeño y las dificultades cognitivas subyacentes.