El día de la semana en la exploración de la orientación en el tiempo / Day of the week for the assessment of orientation in time

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[Temporal orientation and cognitive impairment]. / Orientacion en el tiempo y deterioro cognitivo.

INTRODUCTION: Temporal orientation is a component of most screening tests for diagnosing cognitive impairment. Correct temporal orientation involves activating both semantic information (concepts of the calendar date) and episodic information (remembering the current date). AIMS: The aim of this study was to assess the diagnostic usefulness of a technique for evaluating temporal orientation, which was open-ended, and scoring the semantic and episodic information thus generated (0-10 points). SUBJECTS AND METHODS: A total of 24 subjects without impairment, 77 patients with mild cognitive impairment (MCI) and 62 patients with dementia were evaluated by means of a 30-point mini-mental/mini-examination, semantic verbal fluency test, global deterioration scale, mini-mental-type temporal orientation and open-ended temporal orientation tests. The areas under the curve (aROC), sensitivity and specificity for dementia and cognitive impairment at any degree (MCI and dementia) were analysed. RESULTS: Open-ended temporal orientation presented a greater area under the curve (aROC: 0.90) for discrimination between patients with dementia and without dementia (MCI and without impairment) and an aROC of 0.83 for discrimination between patients with MCI or dementia and without impairment. For dementia, with a cut-off point equal to or below 6, sensitivity was 0.96 and specificity was 0.68, and for MCI with dementia, with a cut-off point equal to or below 7, sensitivity was 0.72 and specificity was 0.92. CONCLUSIONS: The usefulness, conciseness and strategic position of this technique in examining mental status make it suitable as an instrument for screening for cognitive impairment. It has a high level of sensitivity with low specificity for dementia and low sensitivity with high specificity for any degree of impairment.

La exploración de la fluidez verbal semántica con tareas alternativas a la categoría «animales» / Exploration of the semantic verbal fluency with alternatives to the «animal» category tasks

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[Model of analysis in two halves for semantic fluency tasks]. / Modelo de análisis en dos mitades para tareas de fluidez semántica.

INTRODUCTION: Semantic verbal fluency (SVF) tasks involve the activation of language, semantic memory, working memory and the executive functions. The second half of the test increases the demands on working memory and search for lexical items, which can make it more difficult than the first half. AIM: To conduct a pilot study in order to standardise the two halves of the SVF test ('animals' category) in adults over 50 years of age. SUBJECTS AND METHODS: Two verbal fluency tasks (semantic and phonological) and the Spanish version of the Mini-Mental State Examination with working memory were applied in 122 controls (range: 50-89 years), who were distributed according to age and schooling. RESULTS: There is a significant difference between the two halves of the test adjusted for age and schooling (p < 0.0001). Scoring in the second half showed a higher correlation with age, schooling and working memory than the first half. Performance in the two halves was standardised for three age groups (50-59, 60-79 and 80-89 years) and two levels of schooling (high and low). CONCLUSIONS: The number of names in the second half of the SVF test was lower than in the first half in all the groups, which supports the hypothesis of a greater cognitive demand, probably on working memory and the search for lexical items in semantic memory. Having normative values available for the two halves of the SVF test allows simultaneous and independent interpretation of the performance at two levels of intra-task difficulty. This model of analysis complements the traditional assessment and can easily be applied in day-to-day clinical practice.

Modelo de análisis en dos mitades para tareas de fluidez semántica / Model of analysis in two halves for semantic fluency tasks

Introducción. Las tareas de fluidez verbal semántica (FVS) implican la activación del lenguaje, la memoria semántica, la memoria de trabajo y las funciones ejecutivas. En la segunda mitad del test aumentan las demandas sobre la memoria de trabajo y la búsqueda lexical, lo que puede aumentar su dificultad relativa respecto de la primera mitad. Objetivo. Estudio piloto de estandarización de las dos mitades del test de FVS, categoría ‘animales’, en adultos mayores de 50 años. Sujetos y métodos. Se aplicaron dos tareas de fluidez verbal (semántica y fonológica) y el miniexamen cognitivo con memoria de trabajo en 122 controles (rango: 50-89 años), distribuidos por edad y escolarización. Resultados. Existe una diferencia significativa entre las dos mitades del test ajustado por edad y escolarización (p < 0,0001). La puntuación en la segunda mitad mostró una correlación más alta que la primera mitad con la edad, la escolarización y la memoria de trabajo. El rendimiento en ambas mitades se estandarizó para tres grupos por edad (50-59, 60-79 y 80-89 años) y dos niveles de escolarización (alta y baja). Conclusiones. El número de nombres en la segunda mitad del test de FVS fue inferior a la primera mitad en todos los grupos, lo que apoya la hipótesis de una mayor demanda cognitiva, probablemente en memoria de trabajo y búsqueda lexical en la memoria semántica. La disponibilidad de valores normativos para las dos mitades del test de FVS permite la interpretación simultánea e independiente del rendimiento en dos niveles de dificultad intra-task. Este modelo de análisis complementa la valoración tradicional y se puede aplicar de forma sencilla en la clínica diaria

Introduction. Semantic verbal fluency (SVF) tasks involve the activation of language, semantic memory, working memory and the executive functions. The second half of the test increases the demands on working memory and search for lexical items, which can make it more difficult than the first half. Aim. To conduct a pilot study in order to standardise the two halves of the SVF test (‘animals’ category) in adults over 50 years of age. Subjects and methods. Two verbal fluency tasks (semantic and phonological) and the Spanish version of the Mini-Mental State Examination with working memory were applied in 122 controls (range: 50-89 years), who were distributed according to age and schooling. Results. There is a significant difference between the two halves of the test adjusted for age and schooling (p < 0.0001). Scoring in the second half showed a higher correlation with age, schooling and working memory than the first half. Performance in the two halves was standardised for three age groups (50-59, 60-79 and 80-89 years) and two levels of schooling (high and low). Conclusions. The number of names in the second half of the SVF test was lower than in the first half in all the groups, which supports the hypothesis of a greater cognitive demand, probably on working memory and the search for lexical items in semantic memory. Having normative values available for the two halves of the SVF test allows simultaneous and independent interpretation of the performance at two levels of intra-task difficulty. This model of analysis complements the traditional assessment and can easily be applied in day-to-day clinical practice

[Language and cognitive impairment: a semiological study into visual naming]. / Lenguaje y deterioro cognitivo: un estudio semiológico en denominación visual.

INTRODUCTION: The presence of anomia and/or paraphasias in patients with cognitive impairment suggests an associated deterioration of their language. Visual naming makes it possible to examine these signs in a controlled manner as the target word is already known. AIM. To conduct a semiological study of naming in normal aging, cognitive impairment and language impairment conditions. SUBJECTS AND METHODS: The study consisted in an analysis of nine types of signs (correct response, increased latencies, circumlocutions, absence of response, semantic verbal paraphasias, verbal paraphasias with a similar form, unrelated verbal paraphasias, phonemic paraphasias and neologisms) in a visual naming task (6 items), in two groups with normal language--controls > 70 years and patients with Alzheimer's disease (AD) with onset of amnesia--and two groups with language impairment--vascular aphasia and anomic AD-. RESULTS: Patients failed to perform naming correctly in 4.2% of the responses in controls, 10% in patients with amnesic AD, 30% in patients with vascular aphasia and 50% in patients with anomic AD. Semantic paraphasias were observed in the two groups with normal language abilities (controls and amnesic AD), although frequencies were low. Signs that suggest difficulties in accessing/retrieving lexical items were more frequent in patients with AD and ran parallel to the degree of anomia. One notable finding was the absence of signs of phonological dysfunction in the two groups with AD, regardless of the degree of anomia. CONCLUSIONS: Semiological quantification makes it possible to distinguish differences in the degree of anomia and in the pattern of errors both in controls and in patients with amnesic onset AD and among patients with vascular aphasia and neurodegenerative anomia.

Lenguaje y deterioro cognitivo: un estudio semiológico en denominación visual / Language and cognitive impairment: a semiological study into visual naming

Introducción. La presencia de anomia y/o parafasias enpacientes con deterioro cognitivo sugiere un deterioro asociado dellenguaje. La denominación visual permite explorar estos signos deforma controlada al conocerse la palabra diana. Objetivo. Estudiosemiológico de la denominación en el envejecimiento normal, deteriorocognitivo y deterioro del lenguaje. Sujetos y métodos. Análisisde nueve tipos de signos (respuesta correcta, incremento de latencias,circunloquios, ausencia de respuesta, parafasias verbales semánticas,parafasias verbales con similitud formal, parafasias verbalesno relacionadas, parafasias fonémicas y neologismos), en unatarea de denominación visual (6 ítems), en dos grupos con lenguajenormal –controles > 70 años y pacientes con enfermedad de Alzheimer(EA) de inicio amnésico– y dos grupos con deterioro del lenguaje–afasia vascular y EA anómico–. Resultados. La denominaciónfalló en el 4,2% de las respuestas en controles, el 10% en pacientescon EA amnésico, el 30% en pacientes con afasia vascular y el 50%en pacientes con EA anómico. En los dos grupos con lenguaje normal(controles y EA amnésico) se observaron parafasias semánticas,con frecuencias bajas. Los signos que sugieren dificultad en el acceso/recuperación léxica fueron más frecuentes en los pacientes conEA, de forma paralela al grado de anomia. Destaca la ausencia designos de disfunción fonológica en los dos grupos con EA, de formaindependiente del grado de anomia. Conclusión. La cuantificaciónsemiológica permite objetivar diferencias en el grado de anomia yen el perfil de errores, tanto entre controles y pacientes con EA deinicio amnésico, como entre los pacientes con afasia vascular y anomianeurodegenerativa

Introduction. The presence of anomia and/or paraphasias in patients with cognitive impairment suggests an associateddeterioration of their language. Visual naming makes it possible to examine these signs in a controlled manner as the targetword is already known. Aim. To conduct a semiological study of naming in normal aging, cognitive impairment and languageimpairment conditions. Subjects and methods. The study consisted in an analysis of nine types of signs (correct response,increased latencies, circumlocutions, absence of response, semantic verbal paraphasias, verbal paraphasias with a similarform, unrelated verbal paraphasias, phonemic paraphasias and neologisms) in a visual naming task (6 items), in two groupswith normal language –controls > 70 years and patients with Alzheimer’s disease (AD) with onset of amnesia– and two groupswith language impairment –vascular aphasia and anomic AD–. Results. Patients failed to perform naming correctly in 4.2% ofthe responses in controls, 10% in patients with amnesic AD, 30% in patients with vascular aphasia and 50% in patients withanomic AD. Semantic paraphasias were observed in the two groups with normal language abilities (controls and amnesic AD),although frequencies were low. Signs that suggest difficulties in accessing/retrieving lexical items were more frequent in patientswith AD and ran parallel to the degree of anomia. One notable finding was the absence of signs of phonological dysfunction inthe two groups with AD, regardless of the degree of anomia. Conclusions. Semiological quantification makes it possible todistinguish differences in the degree of anomia and in the pattern of errors both in controls and in patients with amnesic onsetAD and among patients with vascular aphasia and neurodegenerative anomia

Demencia tipo Alzheimer, estudios de correlación cognitivo-funcional y memoria de trabajo / Dementia of Alzheimer type, studies of clinico-functional correlation and working memory

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[Pharmacological treatment of Korsakoff's psychosis: a review of the literature and experience in two cases]. / Tratamiento farmacológico de la psicosis de Korsakoff: revisión de la bibliografía y experiencia en dos casos.

INTRODUCTION: Korsakoff s psychosis (KP) is a relatively frequent pathological condition in our community that has been infradiagnosed. The most common cause is chronic alcohol consumption, although it can be brought about by other aetiologies accompanied by vitamin deficiencies. The lack of thiamine entails an alteration in the synthesis of neurotransmitters, which provides the neurochemical foundation for the specific cognitive impairment that defines the syndrome. AIMS: To evaluate the application of pharmacological treatments, in accordance with the neurochemical disorders described in the literature, and report our experience in two cases treated with anticholinesterases. CASE REPORTS: 1) Female aged 47, with a history of addiction to alcohol. Following Wernicke s encephalopathy, which improved with parenteral thiamine, she presented a memory disorder compatible with KP. After two months treatment with donepezil, a cognitive improvement was observed in the neuropsychological tests. 2) Male aged 77, who presented KP a month after being diagnosed and treated for a post encephalitic vasculitis caused be varicella zoster virus. His cognitive and functional condition improved after 3 months treatment with donepezil. DISCUSSION AND CONCLUSIONS: There are not enough studies in the literature with representative samples that consider the effects of thiamine or of other forms of treatment on cognitive impairment in KP. Noradrenaline, serotonin, glutamate and acetylcholine have been proposed in the pathogeny of the syndrome. Based on experiences gained in cholinergic disorders, two cases responded to treatment with donepezil. Effective treatment must be based on a combination of aetiological and pharmacological treatment, and cognitive rehabilitation.

Tratamiento farmacológico de la psicosis de Korsakoff:revisión de la bibliografía y experiencia en dos casos / Pharmacological treatment of korsakoff's psychosis: a review of the literature and experience in two cases

Introducción. La psicosis de Korsakoff (PK) constituye una patología relativamente frecuente en nuestro medio y se ha infradiagnosticado. La causa más habitual es el consumo crónico de alcohol; pueden producirla otras etiologías que cursen con déficit vitamínicos. La carencia de tiamina conlleva una alteración en la síntesis de neurotransmisores, que constituye la base neuroquímica de los específicos déficit cognitivos que definen el síndrome. Objetivo. Evaluar la aplicación de tratamientos farmacológicos, según los trastornos neuroquímicos descritos en la literatura, y exponer nuestra experiencia en dos casos tratados con anticolinesterásicos. Casos clínicos. 1) Mujer de 47 años, con antecedentes de adicción al alcohol. Tras cuadro de encefalopatía de Wernicke, que mejora con tiamina parenteral, presenta trastorno de memoria compatible con PK. A los dos meses de tratamiento con donepecilo se observa mejoría cognitiva en los tests neuropsicológicos. 2) Varón de 77 años, que presenta PK al mes de haberse diagnosticado y tratado de una vasculitis postencefalitis por virus varicela zoster. Mejora su estado cognitivo y funcional a los tres meses de tratamiento con donepecilo. Discusión y conclusiones. No existen estudios suficientes en la literatura con muestras representativas de pacientes que valoren los efectos de la tiamina ni de otros tratamientos sobre los defectos cognitivos de la PK. Noradrenalina, serotonina, glutamato y acetilcolina se han postulado en la patogenia del síndrome. Sobre la base de los trastornos colinérgicos, dos casos han experimentado respuesta al tratamiento con donepecilo. La terapéutica se sustenta en la combinación de tratamiento etiológico, farmacológico y rehabilitación cognitiva (AU)