Valor diagnóstico y correlaciones funcionales de la escala ADAS-Cog en la enfermedad de Alzheimer: datos del proyecto NORMACODEM / Diagnostic value and functional correlations of the ADAS-Cog scale in Alzheimer's disease: data on NORMACODEM project

Introducción. El objetivo es estudiar la validez de criterio de la Alzheimer's Disease Assessment Scale (ADAS) y de su subescala cognitiva ADAS-Cog para el diagnóstico de la enfermedad de Alzheimer (EA) y determinar diferentes puntos de corte obteniendo la sensibilidad y especificidad diagnósticas respectivas. Además se pretenden estudiar las correlaciones de las puntuaciones de la escala ADAS con medidas funcionales.Métodos. Se estudiaron 451 sujetos (254 controles sanos,86 casos con deterioro cognitivo sin demencia y 111 sujetos afectos de EA). Se obtuvieron las puntuaciones de la escala ADAS-total. La puntuación global es la resultante de la suma de dos subtests: la subescala cognitiva (ADAS-Cog) y la subescala no cognitiva (ADAS-Nocog). Se aplicaron ajustes por edad y escolaridad correspondientes para cada sujeto. A fin de poder establecer la correlación con medidas funcionalesse administraron la Rapid Disability Rating Scale-2(RDRS-2), la Blessed Dementia Rating Scale (BDRS) y la escala Interview for Detererioration of Daily Living in Dementia (IDDD). El estudio estadístico se realizó mediante las curvas ROC y el coeficiente de correlación de Pearson. Resultados. El punto de corte más equilibrado para la ADAS-total ajustado por edad y escolaridad fue de >= 17 (sensibilidad: 90,09 %, y especificidad: 85,88%). El punto de corte más equilibrado del ADAS-Cog ajustado por edad y escolaridad fue de >= 12 (sensibilidad: 89,19 %, y especificidad: 88,53%). El área bajo la curva ROC fue, respectivamente, 0,95 y 0,94. La escala ADAS-total y ADAS-Cog presentan buenas correlaciones con las escalas funcionales estudiadas. Conclusiones. Tanto la ADAS-total como la ADAS-Cog presentan una buena validez discriminativa en términos de sensibilidad, especificidad y valor predictivo. Asimismo existe una buena correlación entre el deterioro funcional estudiado en los pacientes con EA y la puntuación obtenida en ambas escalas

Introduction. The aims of this study were to assessthe criterion validity of Alzheimer's Disease AssessmentScale (ADAS) and its cognitive subscale (ADAS-Cog) forthe diagnosis of Alzheimer’s disease (AD), and to determine their different cut-off scores and sensitivity and specificity values. In addition, we also attempted tostudy the possible correlations between cognitive scores(ADAS) and functional measures. Methods. 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with AD). ADAS total score was obtained by adding the cognitive (ADAS-Cog) and non-cognitive (ADAS-Nocog) scales. Scores were adjusted for age and formal education. For assessing the possible correlation between cognitive and functional measures, the following instruments were administered: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS) and the Interview for the Deterioration of Daily Living in Dementia (IDDD). Statistical analysis: ROC curves and Pearson correlation coefficient. Results. ADAS best cut-off score for dementia was >=17 providing sensitivity and specificity values of 90.09% and 85.88 % respectively, while for the ADAS-Cog best cut-off score was >= 12 with sensitivity and specificity values of 89.19 % and 88.53 % respectively. In both cases scores were adjusted for age and formal education. The area under the ROC curve was 0.95 and 0.94 respectively. Highly significant correlations were found for ADAS and 19 ADAS-Cog with the functional scales studied. Conclusions. Both, ADAS and ADAS-Cog report good validity in terms of sensitivity, specificity and as predictive value for AD. Moreover, significant correlations were found between the functional impairment observed in patients with AD and the overall scores achieved in the ADAS and ADAS-Cog

Frequency of sexual dysfunction and other reproductive side-effects in patients with schizophrenia treated with risperidone, olanzapine, quetiapine, or haloperidol: the results of the EIRE study.

Atypical antipsychotics seem to differ mainly in their tolerability profile. The aim of this cross-sectional study, the Estudio de Investigaci n de Resultados en Esquizofrenia (Outcomes Research Study in Schizophrenia; EIRE study), was to assess in a clinical setting the frequency of several side-effects related to haloperidol, risperidone, olanzapine, and quetiapine. This article addresses sexual dysfunction and other reproductive side-effects (gynecomastia, menorrhage, amenorrhea, and galactorrhea). We recruited outpatients diagnosed with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) criteria and who had received a single antipsychotic (risperidone, olanzapine, quetiapine, or haloperidol) for at least 4 weeks. During a single visit, we collected data, including demographic and clinical characteristics, current antipsychotic and concomitant treatment, and adverse effects listed in a modified version of the UKU Scale. We used a Chi-squared test to determine pairs comparisons of the frequency of adverse reactions between treatments. To estimate risk of a given adverse reaction with a given treatment, we used a logistic regression method. We assessed 636 evaluable patients out of 669 recruited. Frequency of sexual dysfunction was high with haloperidol (38.1%) and also with olanzapine (35.3%), quetiapine (18.2%), and risperidone (43.2%). We found the frequency of other reproductive side-effects to be relatively low with all four drugs: haloperidol (6.9%), olanzapine (6.4%), quetiapine (2.7%), and risperidone (11.7%). Sexual dysfunction appeared to be dose-related with haloperidol, risperidone, and olanzapine. Risperidone and olanzapine showed a higher risk of sexual dysfunction and other reproductive sideeffects than haloperidol. Quetiapine showed a lower risk of sexual dysfunction during short-term treatment (< 12 weeks). However, data on longer-term treatment (> 12 weeks) are lacking. Our results suggest that none of the atypical antipsychotics that we studied significantly improved sexual dysfunction and other reproductive side-effects of the conventional antipsychotic, haloperidol, in stabilized patients during long-term treatment. Quetiapine appears to improve this profile during short-term treatment; however, longterm data, with larger samples, are required with this latter drug.