Variabilidad en el rendimiento neuropsicológico en pacientes con síndrome coronario agudo / Variability in the neuropsychological performance of patients with acute coronary syndrome

Introducción: Existe un interés creciente por el estudio de la relación entre las cardiopatías, incluido el síndrome coronario agudo (SCA) y el deterioro cognitivo, y, aunque no se conocen con concreción los factores que median entre el SCA y el deterioro cognitivo, en el centro de este debate se encuentra el papel de la fracción de eyección del ventrículo izquierdo (FEVI). Objetivos: Determinar la presencia de deterioro cognitivo en pacientes con SCA y explorar su asociación con diversos factores –sociodemográficos, consumo de fármacos, rendimiento en pruebas funcionales cardíacas (en particular, la FEVI)–. Pacientes y métodos: Se recogieron variables sociodemográficas, médicas y neuropsicológicas en 80 pacientes con SCA que participaban en un programa de rehabilitación cardíaca. Se compararon sus puntuaciones en la batería neuropsicológica con los datos normativos poblacionales para determinar qué sujetos mostraban un rendimiento deficitario. Se realizaron análisis de regresión para determinar qué factores se asocian con el rendimiento en las pruebas neuropsicológicas. Resultados: En comparación con su grupo normativo, el 37,5% de los sujetos presentó una baja puntuación en tres o más test neuropsicológicos. La edad, un bajo nivel educativo y una FEVI baja explicaron hasta el 51% de la variabilidad en los resultados de las pruebas neuropsicológicas. Conclusiones: Los pacientes con SCA tienen más posibilidades de presentar un deterioro de funciones cognitivas, como la atención, la memoria y las funciones ejecutivas, junto con un enlentecimiento en la velocidad de procesamiento de la información. Una FEVI inferior al 50% podría ser un factor explicativo destacado de dicho deterioro cognitivo.

Introduction: There is a growing interest in the study of the relationship between heart disease, including acute coronary syndrome (ACS) and cognitive impairment, and although the factors mediating ACS and cognitive impairment are not well understood, the debate revolves around the role of the left ventricular ejection fraction (LVEF). Aims: To determine the presence of cognitive impairment in patients with ACS and explore its association with various factors, including sociodemographic, medication use and performance on cardiac function tests (in particular LVEF). Patients and methods: Sociodemographic, medical and neuropsychological variables were collected in 80 patients with ACS participating in a cardiac rehabilitation programme. Their scores on the neuropsychological battery were compared with normative population data to determine which subjects showed deficient performance. Regression analyses were conducted to determine which factors are associated with performance on neuropsychological tests. Results: Compared to their normative group, 37.5% of the subjects had low scores on three or more neuropsychological tests. Age, low educational level and low LVEF explained up to 51% of the variability in neuropsychological test results. Conclusions. Patients with ACS are more likely to have impaired cognitive functions, such as attention, memory and executive functions, along with a slower information processing speed. An LVEF below 50% could be a major explanatory factor for such cognitive impairment.(AU)

[Variability in the neuropsychological performance of patients with acute coronary syndrome]. / Variabilidad en el rendimiento neuropsicológico en pacientes con síndrome coronario agudo.

INTRODUCTION: There is a growing interest in the study of the relationship between heart disease, including acute coronary syndrome (ACS) and cognitive impairment, and although the factors mediating ACS and cognitive impairment are not well understood, the debate revolves around the role of the left ventricular ejection fraction (LVEF). AIMS: To determine the presence of cognitive impairment in patients with ACS and explore its association with various factors, including sociodemographic, medication use and performance on cardiac function tests (in particular LVEF). PATIENTS AND METHODS: Sociodemographic, medical and neuropsychological variables were collected in 80 patients with ACS participating in a cardiac rehabilitation programme. Their scores on the neuropsychological battery were compared with normative population data to determine which subjects showed deficient performance. Regression analyses were conducted to determine which factors are associated with performance on neuropsychological tests. RESULTS: Compared to their normative group, 37.5% of the subjects had low scores on three or more neuropsychological tests. Age, low educational level and low LVEF explained up to 51% of the variability in neuropsychological test results. CONCLUSIONS: Patients with ACS are more likely to have impaired cognitive functions, such as attention, memory and executive functions, along with a slower information processing speed. An LVEF below 50% could be a major explanatory factor for such cognitive impairment.

TITLE: Variabilidad en el rendimiento neuropsicológico en pacientes con síndrome coronario agudo.Introducción. Existe un interés creciente por el estudio de la relación entre las cardiopatías, incluido el síndrome coronario agudo (SCA) y el deterioro cognitivo, y, aunque no se conocen con concreción los factores que median entre el SCA y el deterioro cognitivo, en el centro de este debate se encuentra el papel de la fracción de eyección del ventrículo izquierdo (FEVI). Objetivos. Determinar la presencia de deterioro cognitivo en pacientes con SCA y explorar su asociación con diversos factores ­sociodemográficos, consumo de fármacos, rendimiento en pruebas funcionales cardíacas (en particular, la FEVI)­. Pacientes y métodos. Se recogieron variables sociodemográficas, médicas y neuropsicológicas en 80 pacientes con SCA que participaban en un programa de rehabilitación cardíaca. Se compararon sus puntuaciones en la batería neuropsicológica con los datos normativos poblacionales para determinar qué sujetos mostraban un rendimiento deficitario. Se realizaron análisis de regresión para determinar qué factores se asocian con el rendimiento en las pruebas neuropsicológicas. Resultados. En comparación con su grupo normativo, el 37,5% de los sujetos presentó una baja puntuación en tres o más test neuropsicológicos. La edad, un bajo nivel educativo y una FEVI baja explicaron hasta el 51% de la variabilidad en los resultados de las pruebas neuropsicológicas. Conclusiones. Los pacientes con SCA tienen más posibilidades de presentar un deterioro de funciones cognitivas, como la atención, la memoria y las funciones ejecutivas, junto con un enlentecimiento en la velocidad de procesamiento de la información. Una FEVI inferior al 50% podría ser un factor explicativo destacado de dicho deterioro cognitivo.

Abnormal thermography in Parkinson's disease.

BACKGROUND: An autonomic denervation and abnormal vasomotor reflex in the skin have been described in Parkinson's disease (PD) and might be evaluable using thermography with cold stress test. METHODS: A cross-sectional pilot study was undertaken in 35 adults: 15 patients with PD and abnormal [(123)I]-metaiodobenzylguanidine cardiac scintigraphy and 20 healthy controls. Baseline thermography of both hands was obtained before immersing one in cold water (3 ± 1 °C) for 2 min. Continuous thermography was performed in: non-immersed hand (right or with lesser motor involvement) during immersion of the contralateral hand and for 6 min afterward; and contralateral immersed hand for 6 min post-immersion. The region of interest was the dorsal skin of the third finger, distal phalanx. RESULTS: PD patients showed a lower mean baseline hand temperature (p = 0.037) and greater thermal difference between dorsum of wrist and third finger (p = 0.036) and between hands (p = 0.0001) versus controls, regardless of the motor laterality. Both tests evidenced an adequate capacity to differentiate between groups: in the non-immersed hand, the PD patients did not show the normal cooling pattern or final thermal overshoot observed in controls (F = 5.29; p = 0.001), and there was an AUC of 0.897 (95%CI 0.796-0.998) for this cooling; in the immersed hand, thermal recovery at 6 min post-immersion was lesser in patients (29 ± 17% vs. 55 ± 28%, p = 0.002), with an AUC of 0.810 (95%CI 0.662-0.958). CONCLUSIONS: PD patients reveal abnormal skin thermal responses in thermography with cold stress test, suggesting cutaneous autonomic dysfunction. This simple technique may be useful to evaluate autonomic dysfunction in PD.

Estudio FOTOTRANS: estudio multicéntrico sobre la validez del Fototest en condiciones de práctica clínica / FOTOTRANS Study. Multicentre study on the validity of Fototest under clinical practice conditions

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 (AU)

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 (AU)

[FOTOTRANS study: multicentre study on the validity of Fototest under clinical practice conditions]. / Estudio FOTOTRANS: estudio multicéntrico sobre la validez del Fototest en condiciones de práctica clínica.

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.

Normative and reliability study of Fototest.

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.

Estudio normativo y de fiabilidad del fototest / Normative and reliability study of fototest

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 (AU)

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 (AU)

Change of the melanocortin system caused by bilateral subthalamic nucleus stimulation in Parkinson's disease.

OBJECTIVES - Determine whether bilateral subthalamic nucleus stimulation (STN-DBS) in Parkinson's disease (PD) is associated with an increase in neuropeptide Y (NPY) and/or resistance to inhibition by leptin in relation to post-surgery weight gain. MATERIALS AND METHODS - This prospective study included 20 patients who underwent bilateral STN-DBS and 17 who refused surgery. Data were obtained at baseline, 3 and 6 months on neurological and nutritional status, including determination of body mass index (BMI) and serum NPY and leptin levels. RESULTS - NPY and leptin levels changed over time, with a distinct pattern. The BMI increase at 6 months was greater in the surgical group (5.5 ± 6.3% vs 0.5 ± 3.5%; P = 0.035). Medical group exhibited a reduction in leptin level (-2.0 ± 4.3 ng/ml) and a consequent increase in NPY level (72.4 ± 58.7 pmol/ml). However, STN-DBS patients showed an increase in leptin (3.1 ± 5.0 ng/ml; P = 0.001 vs medical group) and also in NPY (12.1 ± 53.6 pmol/ml; P = 0.022 vs medical group) levels, which suggests resistance to inhibition by leptin. Rise in NPY level correlated with higher stimulation voltages. CONCLUSIONS - Bilateral STN-DBS causes disruption of the melanocortin system, probably related to diffusion of the electric current to the hypothalamus. This mechanism may in part explain the weight gain of patients with PD after surgery.

Nombres de personas: una prueba de fluidez verbal sin influencias socioeducativas / Names of persons: a verbal fluency test without socioeducational influences

Introducción. Las tareas de fluidez verbal semántica(FVS) se emplean ampliamente por su facilidad, brevedad yutilidad diagnóstica (UD), pero tienen el inconveniente deestar muy influidas por variables socioeducativas. Nuestroobjetivo es evaluar la posible influencia de estas variables enla tarea de fluidez «nombres de personas» (FVS-np).Métodos. Estudio transversal en 226 pacientes neurológicosclasificados en demencia (criterios DSM-IV), deteriorocognitivo sin demencia (criterios GENCyD-SEN) y no deteriorocognitivo a los que se aplicó una prueba de FVS-np yla prueba clásica de fluidez verbal «nombres de animales»(FVS-an). Se evaluó la UD de sus resultados para demencia ydeterioro cognitivo mediante el cálculo y comparación delárea bajo la curva ROC (aROC); asimismo se evaluó la influenciaen los resultados de las variables socioeducativas ydel estado cognitivo mediante un estudio de regresión linealmúltiple.Resultados. No hay diferencia significativa entre la UDde la FVS-np y FVS-an para demencia (0,88 ± 0,02 [aROC ±error estándar, ee] frente a 0,90 ± 0,02, respectivamente) nipara deterioro cognitivo (0,88 ± 0,02 frente a 0,87 ± 0,02).Los resultados de la FVS-an están asociados a la edad, el sexo,el nivel educativo y el estado cognitivo del sujeto, encambio los de la FVS-np sólo dependen del estado cognitivo.Discusión. La tarea de FVS-np tiene las mismas ventajasy UD que la FVS-an, pero disfruta de la ventaja adicional deno estar influenciada por variables socioeducativas, no precisandoajustes ni correcciones de puntuación. Esta independenciala hace especialmente apta para su uso en poblacionesmulticulturales y con bajo nivel educativo (AU)

Introduction. Semantic verbal fluency (SVF) tasksare widely used because of their simplicity, brevity anddiagnostic accuracy (DA). However, they have the disadvantageof being greatly influenced by socioeducationalvariables. Our objective is to assess the possible influenceof these variables on the fluency test «names of persons» (SVF-np).Methods. Cross-sectional study in 226 neurologypatients classified in dementia (DSM-IV criteria), cognitiveimpairment without dementia (GENCyD-SEN criteria)and non-cognitive impairment who responded to aSVF-np test and to the classical test of verbal fluency,«names of animals» (SVF-an), evaluating the DA of theirresults for both dementia and cognitive impairment bycalculating and comparing the area under the ROC curve(aROC). In addition, the influence of the socioeducationalvariables and cognitive state on the results was assessedthrough multiple linear regression analysis.Results. There were no significant differences betweenthe DA of the SVF-np and SVF-an for dementia(0.88 ± 0.02 [aROC ± SD] vs. 0.90 ± 0.02, respectively) orfor cognitive impairment (0.88±0.02 vs. 0.87±0.02). Thescores of the SVF-an task were associated with age, sex,educational level and cognitive status of the subject. Onthe contrary, those of the SVF-np task only dependedon the cognitive status.Discussion. The SVF-np task has the same advantagesand DA as the SVF-an, but it has the additional advantageof not being influenced by socioeducational variables andnot requiring score adjustments or corrections. This independencemakes it especially appropriate for use inmulticultural populations and persons with low educationallevel (AU)

[Names of persons: a verbal fluency test without socioeducational influences]. / Nombres de personas: una prueba de fluidez verbal sin influencias socioeducativas.

INTRODUCTION: Semantic verbal fluency (SVF) tasks are widely used because of their simplicity, brevity and diagnostic accuracy (DA). However, they have the disadvantage of being greatly influenced by socioeducational variables. Our objective is to assess the possible influence of these variables on the fluency test "names of persons" (SVF-np). METHODS: Cross-sectional study in 226 neurology patients classified in dementia (DSM-IV criteria), cognitive impairment without dementia (GENCyD-SEN criteria) and non-cognitive impairment who responded to a SVF-np test and to the classical test of verbal fluency "names of animals" (SVF-an), evaluating the DA of their results for both dementia and cognitive impairment by calculating and comparing the area under the ROC curve (aROC). In addition, the influence of the socioeducational variables and cognitive state on the results was assessed through multiple linear regression analysis. RESULTS: There were no significant differences between the DA of the SVF-np and SVF-an for dementia (0.88 +/- 0.02 [aROC +/- SD] vs. 0.90 +/- 0.02, respectively) or for cognitive impairment (0.88 +/- 0.02 vs. 0.87 +/- 0.02). The scores of the SVF-an task were associated with age, sex, gender, educational level and cognitive status of the subject. On the contrary, those of the SVF-np task only depended on the cognitive status. DISCUSSION: The SVF-np task has the same advantages and DA as the SVF-an, but it has the additional advantage of not being influenced by socioeducational variables and not requiring score adjustments or corrections. This independence makes it especially appropriate for use in multicultural populations and those persons with low educational level.

Utilidad diagnóstica del Test de las Fotos (Fototest) en deterioro cognitivo y demencia / Diagnostic accuracy of the Phototest for cognitive impairment and dementia

Introducción. El Test de las Fotos (Fototest) es un testrecientemente descrito, fácil, simple y muy breve (<3 min),con ventajas teóricas sobre los tests de cribado de demenciadisponibles. Nuestro objetivo es evaluar su utilidad diagnósticaen condiciones de práctica clínica habitual. Material y métodos. Estudio transversal en fase II de validaciónde pruebas diagnósticas en una muestra de 308 pacientesatendidos en la consulta de neurología general enriquecidacon 70 sujetos sanos. Se evaluó la utilidad diagnóstica (UD)del Fototest y se comparó con la del Eurotest y un test defluencia verbal (TFV) frente al diagnóstico clínico de demencia(DEM) y deterioro cognitivo (DET) mediante el cálculodel área bajo la curva ROC (aROC) y la determinación de losvalores de sensibilidad (S), especificidad (E) y cocientes deprobabilidad (CP). Resultados. La muestra total estaba compuesta por225 sujetos sin deterioro cognitivo (NOR), 58 con DET sinDEM y 95 DEM; los resultados del Fototest en los sujetosNOR se distribuyen normalmente (33,4±3,9 [media±desviaciónestándar]) y no están influenciados por variables educativas.La UD del Fototest para DEM y DET (0,95±0,01 [aROC±ee]) es similar a la del Eurotest y ambas superiores a las delTFV. El punto de corte 25/26 para DEM (S=0,88 [0,80-0,94]y E=0,90 [0,86-0,93]) y 28/29 para DET (S=0,90 [0,84-0,94] yE=0,90 [0,83-0,93]) maximizan la suma de S y E. Conclusiones. El Fototest es un test muy breve, fácil,aplicable a analfabetos, no influenciado por variables educativasy útil para la identificación de DET y DEM en la prácticaclínica cotidiana

Introduction. The recently developed Phototest is asimple, easy and very brief (<3 minutes) test with theoreticaladvantages over available dementia screeningtests. Our objective was to evaluate its diagnostic accuracyunder routine clinical conditions. Material and methods. A phase II cross-sectionalvalidation study of diagnostic tests was performed in asample of 308 patients referred to a general neurologydepartment and in a group of 70 healthy individuals.The diagnostic accuracy (DA) of the Phototest was assessedand compared with that of the Eurotest and a verbalfluency test (VFT) in relation to the clinical diagnosis ofdementia (DEM) and cognitive impairment (CI) by calculatingthe area under the ROC curve (aROC) and determiningSensitivity (Se), Specificity (Sp) and likelihood ratios. Results. The total sample comprised 225 subjects withoutCI (NOR), 58 with CI and without DEM and 95 withDEM. Phototest results showed a normal distribution inNOR subjects (33.4 ± 3.9 [mean ± standard desviation])and were not influenced by educational variables. TheDA of the Phototest for DEM and CI (0.95 ± 0.01[aROC±Se]) was similar to that of the Eurotest and higherfor both tests than that of the VFT. The cutoff pointsof 25/26 for DEM (Se=0.88 [0.80-0.94], Sp=0.90 [0.86-0.93]) and 28/29 for CI (Se=0.90 [0.84-0.94], Sp=0.90[0.83-0.93]) maximised the sum of Se and Sp. Conclusions. The Phototest is a very short test ofeasy application that is applicable to illiterate subjects,uninfluenced by educational variables and useful toidentify CI and DEM in routine clinical practice

[Diagnostic accuracy of the Phototest for cognitive impairment and dementia]. / Utilidad diagnóstica del Test de las Fotos (Fototest) en deterioro cognitivo y demencia.

INTRODUCTION: The recently developed Phototest is a simple, easy and very brief (<3 minutes) test with theoretical advantages over available dementia screening tests. Our objective was to evaluate its diagnostic accuracy under routine clinical conditions. MATERIAL AND METHODS: A phase II cross-sectional validation study of diagnostic tests was performed in a sample of 308 patients referred to a general neurology department and in a group of 70 healthy individuals. The diagnostic accuracy (DA) of the Phototest was assessed and compared with that of the Eurotest and a verbal fluency test (VFT) in relation to the clinical diagnosis of dementia (DEM) and cognitive impairment (CI) by calculating the area under the ROC curve (aROC) and determining Sensitivity (Se), Specificity (Sp) and likelihood ratios. RESULTS: The total sample comprised 225 subjects without CI (NOR), 58 with CI and without DEM and 95 with DEM. Phototest results showed a normal distribution in NOR subjects (33.4 +/- 3.9 [mean +/- standard desviation]) and were not influenced by educational variables. The DA of the Phototest for DEM and CI (0.95 +/- 0.01 [aRO C+/- Se]) was similar to that of the Eurotest and higher for both tests than that of the VFT. The cutoff points of 25/26 for DEM (Se=0.88 [0.80-0.94], Sp=0.90 [0.86- 0.93]) and 28/29 for CI (Se=0.90 [0.84-0.94], Sp=0.90 [0.83-0.93]) maximised the sum of Se and Sp. CONCLUSIONS: The Phototest is a very short test of easy application that is applicable to illiterate subjects, uninfluenced by educational variables and useful to identify CI and DEM in routine clinical practice.