[Spanish version of the 7 Minute screening neurocognitive battery. Normative data of an elderly population sample over 70]. / Versión española del Test de los 7 Minutos. Datos normativos de una muestra poblacional de ancianos de más de 70 años.

INTRODUCTION: To standardize the Spanish version of the 7 Minute screening neurocognitive battery (7MS) in a population sample of elderly over 70 years. METHODS: We examined 416 persons, living at home, participating in elderly the longitudinal study "Aging in Leganes", aged 71 to 99 years old (mean age: 79 +- 9.2 years; 51.7 % women; 10.6 illiterate, 25 % without formal education). In order to do so, we used an extensive clinical survey, general and neurological exam and extensive neuropsychological battery with several cognitive scales, attention, language, memory, visuomotor skill and reasoning tests, Jorm's IQCODE questionnaire, CES-D depression questionnaire and the 7MS including the Benton Orientation Test, Clock Drawing Test, Free and Cued Learning Test and Categorial Verbal Fluency. Dementia was diagnosed according to DSM-IV criteria but independently of the 7MS scores. Several methods to obtain the total score of the 7MS were analyzed and the normative parameters of the test were obtained in the subgroup of non-demented subjects. RESULTS: The easiest and most efficient method to obtain the total score of the 7MS was the sum of the z-scores of the four subtests. We present the mean values, -1 and -1.5 standard deviations, range and percentiles of the partial and total scores of the 7MS stratified by age (71-75, 76-80, 81-85 and > or = 86 years) and education (less than primary education and primary education or greater) in the subgroup of non-demented subjects. CONCLUSIONS: The normative data of the 7MS obtained in a representative sample of the general elderly population support its rigorous use in the Spanish clinical setting.

[Present and future of neurology in Spain]. / Presente y futuro de la neurología española.

This is a document prepared by the Spanish Society of Neurology (SEN), which was given to the President of Spain (Mr. José María Aznar) last September with the main aim of examining the current situation of Neurology in our country. It analyses the present and future of Neurology in clinical assistance, teaching and research. To prepare this document the criteria of patients' associations has been considered, including the Declaration of Madrid which has been subscribed by thirty of these associations. In spite of its relevant development in the previous decades, the current situation of Neurology in Spain is far from the ideal. To reach the recommendable menber of 3 or 4 neurologists per 100,000 inhabitants it is necessary to duplicate the present number of neurologists which has been estimated around 2/100,000; this situation is especially urgent in some Autonomous Communities. The most important problems in neurological assistance are: inadequate follow-up of the chronic outpatients, low numbers of neurological beds and of duties of Neurology, as well as of neurological case of patients with urgent neurological disorders. It is also necessary to increase the number of professors of Neurology to adequately cover pregraduate teaching; again there are important differences in teaching positions among Autonomous Communities. Neurology residence should be prolonged from 4 to 5 years. Finally, it is necessary to support the appearance of superespecialised units and to promote a coordinated research with other close specialities including basic neuroscience.

[Cognitive deficiency in mild hypothyroidism]. / Déficit cognitivo en el hipotiroidismo leve.

OBJECTIVE: Moderate and severe primary adult hypothyroidism produces cognitive and behavioral disturbances, but the effects of mild hypothyroidism are not well established. We have tried to determine the pattern of cognitive performance and the effect of hormonal treatment in mild hypothyroidism. PATIENTS AND METHODS: 15 patients with subclinical or very mild hypothyroidism were compared with other 15 patients suffering from mild diseases without central nervous system damage, who were matched in age, sex and previous intelligence. A neuropsychological battery, including tests of global cognitive performance (Mini Mental Status Examination, WAIS), attention (reaction time), visual memory (Benton test, Rey's Figure), verbal memory (word learning), verbal fluency and executive functions (Trail Making Test), was applied. RESULTS: Hypothyroid patients had worse performance in some WAIS subtests, reaction time, verbal fluency, free recall and copy of the Rey's figure. After hormonal treatment, a significant improvement and normal performance in almost all cognitive functions were found. CONCLUSIONS: Even mild hypothyroidism produces cognitive defects, mainly in tasks with high attentional requirements, that can and should be corrected with hormonal replacement.

[What sort of stroke requires patient admittance to the hospital? Factors for deciding on hospitalization]. / Cómo es el ictus del paciente que ingresamos? Factores de decisión en la hospitalización.

OBJECTIVE: To study main factors determining medical decision in admitting patients with acute cerebrovascular disease (ACVD). PATIENTS AND METHODS: This is an observational and transversal study. We analyze a hospitalary cohort made by all consecutive patients with ACVD coming to Emergency Room to Hospital Universitario de la Princesa during 1 year. Neurologist on call made on his/her own decision to admit the patient to hospital. Clinical and epidemiological characteristics of those patients admitted with those who went home are compared. RESULTS: 517 patients were studied, 147 had transient ischemic attacks (TIA) and 370 had a stroke, 12.3% TIA and 68.4% stroke patients were hospitalized. Age, Canadian Stroke Scale (CSS) on admission, subtype of stroke, atrial fibrillation and abnormal EKG, old lesions in CT, previous TIA and/or CVD, diminished conscious level, orientation and language, sphincter control and evolution time greater than 48 hours were statistically significative in deciding admission. Logistic regression analysis (84.2% total predictive value) showed independent predictive value in age, CSS, previous CVD and some subtypes of stroke (ischemic non lacunar and hemorrhage). CONCLUSIONS: We hospitalize younger patients, with a worse clinical condition and overall hemorrhagic stroke. The percentage of admissions among TIA patients is low. On the other hand, date, time and physicians-team features do not affect the percentage of admissions.

A new clinical tool for gait evaluation in Parkinson's disease.

This study was devised to check the feasibility and validity of a rating scale specifically designed to evaluate gait impairment in Parkinson's disease (RSGE). Demographic data, a brief questionnaire on general aspects influencing gait and mobility, a battery of scales (Barthel Index; Hoehn and Yahr staging; and Northwestern University Disability, Schwab and England, and Unified Parkinson's Disease Rating Scale [UPDRS]), and timed tests ("Up and Go" and "Steps x Seconds" tests) were recorded under protocol, as was the RSGE-Version 1.0 (23 items in four subscales). Fifty patients enrolled at two centers were included. Twenty-five (50%) were simultaneously (though independently) evaluated by three examiners, in order to determine the interrater reliability. The mean age of the patients was 67.6 +/- 11.16 years, with a mean 8.18 +/- 5.58 years of disease duration. Motor fluctuations were present in 48% of patients. The RSGE Cronbach's alpha was 0.94. Only the item "Dyskinesias" was not correlated with the RSGE total sum. The item "Axial rigidity" showed a fair interrater reliability (kappa = 0.30). However, most of the RSGE items (16/23, 70%) had kappa > or = 0.65. The convergent validity with the applied scales was very high (Spearman r = 0.74-0.90, p < 0.001). The highest correlation (0.90) was obtained with the UPDRS. Also, the RSGE correlation with timed tests was very satisfactory ("Up and Go" = 0.81; "Steps x Seconds" = 0.70; both, p < 0.001). Factor analysis of the RSGE disclosed four dimensions explaining 68% of the variance. The RSGE-Version 1.0 proved to be a valid instrument. The reliability of some items has to be improved, however.

[Assessing quality of life in Parkinson's disease using the PDQ-39. A pilot study]. / Valoración de la calidad de vida en la enfermedad de Parkinson mediante el PDQ-39. Estudio piloto.

The aim of this pilot study was to analyze an adaptation of the PDQ-39, a Parkinson's disease (PD) quality of life questionnaire, for use in Spanish. Fifty patients were enrolled. Patient characteristics and medical histories were recorded, including scores on the following scales: Hoehn and Yahr (HY), PD unified (UPDRS), Schwab and England (SE), Intermediate Scale for Assessment of PD (ISAPD). Barthel Index (BI), Pfeiffer's SPMSQ, Global Deterioration Scale (GDS), Geriatric Depression Scale (GDS). Hospital Depression and Anxiety Scale (HDA) and the PDQ-39. Descríptive statistics were recorded, as well as Spearman's r and ANOVA results. The dimensions that correlated well with PD scale scores were mobility, daily life activities and cognitive deterioration. The dimension stigma correlated with complications on the UPDRS and the ISAPD. Emotional well-being correlated with subscale I of the UPDRS, the GDS and the HDA (r = 0.39-0.79, p < 0.01-0.001). Physical discomfort correlated only with depression and anxiety. Stage of disease and level of depression influenced most dimensions assessed by the PDQ-39. Some psychosocial factors that are important components of well-being are scarcely reflected by the clinical scales usually applied.

Intermediate scale for assessment of Parkinson's disease. Characteristics and structure.

The present study is devoted to the verification of the basic metrical characteristics of the ISAPD. One hundred and sixty-seven Parkinson's disease (PD) patients were included. Group A (n = 40) was simultaneously assessed by five raters who applied the ISAPD and other PD rating scales (PDRS). A set of timed tests, the MiniMental State Examination (MMSE) and the Hamilton Scale for Depression (HSD) were administered by an independent examiner. Group B (n = 127) was individually assessed through the UPDRS and the other PDRSs by separate neurologists in four different hospitals. The ISAPD was administered in 7.0 +/- 3.7 min. The internal consistency of this scale was high (Cronbach's alpha = 0.97). The inter-rater reliability of their items was very satisfactory (for all items, kappa > 0.70). There was a high correlation with the Hoehn and Yahr classification (r(s) = 0.71; p < 0.001) and some timed tests. The convergent validity with the other PDRS (UPDRS and Schwab and England Scale) was also very high (r(s) = 0.83-0.92; p < 0.001). The ISAPD also correlated with the MMSE and the HSD. Factor analysis identified three factors (activities of daily living; gait and mobility; speech and eating) that explained 76% of the variance. The ISAPD is an easy to apply, reliable, and valid scale that fulfills the aim for which it was designed.

[Validation of the S-IQCODE: the Spanish version of the informant questionnaire on cognitive decline in the elderly]. / Estudio de validación del S-IQCODE: la versión española del informant questionnaire on cognitive decline in the elderly.

Although in the last decade the screening test of dementia have improved, is still being of interest the study of simple methods with a most sensitivity and specificity in the detection of the cognitive decline. Jorm et al have used recently a questionnaire (IQCODE) by which a subject's relative informs of the decline suffered by this in his cognitive capacity. In this work is showed a spanish adaptation of this test, the spanish-IQCODE, analysing it's usefulness for the detection of mild dementia. The S-IQCODE shows a diagnostic validity (sensitivity of 86%, specificity of 92%, positive predictive value of 54% and negative predictive value of 98%) greater than Mini-Mental State Examination (MMSE); it also shows a correlation with the diagnostic of dementia greater (r = 0.70 vs r = 0.37); and, different from MMSE, it doesn't show significative correlations with the age, the schooling and the premorbid intelligence. The results in this study show the S-IQCODE as a good test for the detection of the mild dementia, of greater diagnostic power than the MMSE and less contaminated than this by strange variables to the cognitive decline.

[Dementia. Language and previous intelligence. Review]. / Demencia. Lenguaje e inteligencia previa. Revisión.

Language disorders in patients diagnosed of dementia have been studied by different authors, especially in the last years. Alzheimer type dementia (ATD) causes the greatest damage in language, which is showed in the beginning as an nominal aphasia. Afterwards, ATD patients present a transcortical sensitive aphasia and finally suffer with a complete dumbness or global aphasia. In subcortical dementia (SDC) language functions are relatively kept whereas in vascular dementia (VD) this disorders have a pattern which could be compared with the one that is presented in the pure motor aphasia. In ATD verbal capacities are not disturbed in the same way. Thus, several tests as reading and vocabulary test in a loud voice are relatively resistant to mental damage process and this has been related to previous intellectual level of demented patients. Moreover, this tests are very useful in diagnosis of small dementia.

[Ambulatory neurological care outside of the hospital. Analysis of the demand registered during 18 months in a neurological outpatient clinic]. / La asistencia neurológica ambulatoria extrahospitalaria. Análisis de la demanda registrada durante 18 meses en una consulta jerarquizada de neurología.

The major data from the care demand in a neurological outpatient clinic in the south area of Madrid are reported. 8.9 patients per 1,000 inhabitants are seen. The frequency of visits to this clinic is higher in females and with advancing age. More than one-half of the patients are diagnosed as having conditions not necessarily representing organic neurological disease. It is concluded that a better selection of the patients referred to this clinic should be adequate, as the number of neurologists per 100,000 inhabitants available in this country is not sufficient to care for so high an outpatient care demand.

Psychological disturbances and folic acid in chronic epileptic outpatients.

The relationship between serum folate level and psychological disturbances was studied in a series of 95 chronic epileptic outpatients. All were nondrinkers. Serum folic acid in all cases and vitamin B12 in 83 cases were determined by radioimmunoassay. Only three factors were significantly related with psychological disturbances: serum levels of folic acid were significantly lower and the mean corpuscular volume of the erythrocytes was significantly higher in disturbed patients, particularly in those with the most severe psychiatric syndromes, and the incidence of disturbances was significantly higher in patients treated with three or more drugs. Conversely, variables such as number or type of seizures, duration of epilepsy, duration of treatment, presence of structural neurological lesions, previous mental retardation, or focal temporal lobe disturbances in the EEG did not show any statistical relationship to the presence of psychological disturbances. No relevant relationship was found between serum vitamin B12 and psychological disturbances.