ABSTRACT
INTRODUCTION: Aggressive behaviours are frequent in the different phases of dementia s evolution. These not only constitute a major problem for the families and the caring staff, but cause fatigue and bur out among them. As these behaviours cannot be predicted or understood, the carers experience very complex and anguishing situations. To avoid subjective factors, Patel and Hope designed and validated a scale named RAGE that can be easily used. OBJECTIVE. Adaptation and validation of the RAGE Scale into Spanish. PATIENTS AND METHODS: The scale has been translated, and then retrotranslated to guarantee the semantic equivalence. Afterwards it has been tested on a group of 60 patients (n= 60). All these patients followed the dementia criteria in DSM-IV and their behaviours were considered as relevantly aggressive by their carers. RESULTS: The total score reliability got an r= 0.93 Spearman coefficient. The internal consistency was determined by Cronbach s alpha (0.90) and the valiability test-retest, analysed by Cohen s kappa, obtained a range from 0.57 to 0.85. CONCLUSIONS: All these elements show similar data in comparison to the original scale validation and therefore this version can be considered adequate for Spanish speaking patients within the Spanish culture.
Subject(s)
Aggression/psychology , Alzheimer Disease/psychology , Mental Disorders/diagnosis , Mental Disorders/psychology , Rage , Surveys and Questionnaires , Translating , Aged , Humans , Middle Aged , Reproducibility of Results , Severity of Illness IndexABSTRACT
BACKGROUND: Cummings et al, 1987, hypothesized that Alzheimer dementia type (ADT) patients would present poorer performances than vascular dementia (VD) patients on the neuropsychological tests that mainly involve cortical neurological structures, and that VD would perform worse on tests that mainly involve subcortical structures. The main purpose of the research was to identify a cognitive impairment pattern that discriminates the type of dementia in the initial stages. METHOD: Two groups of patients, one affected by mild ADT (n = 30) and the other by multi-infarct dementia (VD, n = 30) were given a neuropsychological battery. The battery was composed by Temporal Orientation (Benton et al.); Vocabulary, Similarities, Digits, Coding and Kohs (WAIS) of Wechsler; the Colour-Form Test of Weigh; the Trail Making Test (A and B) (Halstead-Reitan Neuropsychological Battery); Tapping (McQuarrie); Logical Memory, Visual Memory and Paired Association (Wechsler Memory Scale) of Wechsler; Delayed Memory (Russell). The two groups were similar in age and socio-cultural features. The z-score and its statistical significance on the Mann-Whitney test were made and we performed an exploratory discriminant analysis to the classification. RESULTS: In general, results were poorer in the ADT group. But we detected no significant differences in the tests, although some test (Immediate Visual Memory and Kohs' Blocks) almost reached significance. The discriminant analysis reached a classification of the 67% of the subjects into the ADT group and the 70% of the subjects into the VD group. CONCLUSIONS: In the initial stages of dementia it is difficult to differentiate between a cortical pattern of cognitive impairment in ADT and a subcortical pattern in VD, a distinction that the other researchers have reported. When complex tests were used the performance depended on the coordination of multiple related systems. These findings are in agreement with the holistic models of higher mental functions.
Subject(s)
Alzheimer Disease/diagnosis , Cognition Disorders/diagnosis , Dementia, Vascular/diagnosis , Aged , Data Interpretation, Statistical , Diagnosis, Differential , Female , Humans , Male , Neuropsychological Tests , Trail Making Test , Wechsler ScalesABSTRACT
INTRODUCTION: The interest about the Clock Drawing Test (CDT) is justified because the importance of praxic disorders and especially the constructive apraxias in demented patients. Generally, this kind of deficits or intellectual losses has been less studied than aphasisas and agnosias. Nevertheless, praxias are usually affected in demential processes, even in initial stages. OBJECTIVE: We try to determine if the CDT can be useful as an assessment tool for dementia. We have used two assessment systems of the clock drawing in order to select an useful and reliable method of correction. PATIENTS AND METHODS: The sample is made up of 35 subjects older than 60 years, they were administered the Mini Cognitive Examination (MCE) and the CDT. Patients with previous diagnosis of dementia, others with physical pathology without neurological affectation and, finally, subjects without any kind of pathology were included in order to get a wide rank of punctuations. We carried out a reliability analysis between two raters and the discriminant validity of the CDT compared to the Spanish adaptation of the Mini Mental Examination. RESULTS: We achieve a high reliability inter examiner rates. Quantitative criteria of both scales are more objective than qualitative ones, therefore, these last should be more operativized. CONCLUSIONS: The results obtained in this work suggest that the clock drawing allow a rapid evaluation of cognitive function as the presence of cognitive impairment.
Subject(s)
Apraxias/diagnosis , Apraxias/etiology , Cognition Disorders/diagnosis , Dementia/complications , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Neuropsychological TestsSubject(s)
Neoplasms , Severity of Illness Index , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prognosis , Terminal CareABSTRACT
BACKGROUND: The presence of multiple symptoms is very frequent in patients with advanced cancer disease. In this situation in which cure is not a realistic aim, the goal is to achieve symptom control and to give support to the patient and family. This study was designed to identify the most common and priority symptoms in patients with advanced cancer. METHODS: Patients were given a questionnaire with a list of symptoms and were asked to underline those they presented, and also number those they considered most distressful from 1-3. Physicians and nurse independently answered the same questionnaire. RESULTS: Asthenia was the most frequent symptom (patient evaluation 84%, nurse 82% and doctor 93%). Psychopathological disturbances showed a high prevalence. Regarding patient evaluation, dry mouth was the third symptom in frequency (73%), but it was detected by nurses in 39% and by physicians in 16%. Priority symptoms for the three groups were pain, asthenia, anorexia and anxiety. Pain was controlled in 19/22 patients (86%), while psychopathological symptoms were only controlled in 7/19 patients (27%). CONCLUSIONS: In order to optimize treatment patient participation is mandatory. An interdisciplinary team (physicians, nurses, social workers, and psychologists) is necessary to take care of these patients.
