Phonological fluency norms for Spanish middle-aged and older adults provided by the SCAND initiative (P, M, & R).

OBJECTIVE: Verbal fluency tests are quick and easy to administer neuropsychological measures and are regularly used in neuropsychological assessment. Additionally, phonological fluency is a widely used paradigm that is sensitive to cognitive impairment. This paper offers normative data of phonological verbal fluency (letters P, M, R) for Spanish middle- and older-aged adults, considering sociodemographic factors, and different measures such as the total number of words, errors (perseveration and intrusions), and 15 sec-segmented scores. METHOD: A total of 1165 cognitively unimpaired participants aged between 50 and 89 years old, participated in the study. Data for P were obtained for all participants. Letters M and R were also administered to a subsample of participants (852) aged 60 to 89 years. In addition, errors and words produced every 15 seconds were collected in the subsample. To verify the effect of sociodemographic variables, linear regression was used. Adjustments were calculated for variables that explained at least 5% of the variance (R2 ≥ .05). RESULTS: Means and standard deviations by age, scaled scores, and percentiles for all tests across different measures are shown. No determination coefficients equal to or greater than .05 were found for sex or age. The need to establish adjustments for the educational level was only found in some of the measures. CONCLUSIONS: The current norms provide clinically useful data to evaluate Spanish-speaking natives from Spain aged from 50 to 89 years. Specific patterns of cognitive impairment can be analyzed using these normative data and may be important in neuropsychological assessment.

Oral health in Alzheimer's disease: a multicenter case-control study.

OBJECTIVES: The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer's patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health. MATERIALS AND METHODS: A total of 70 Alzheimer's patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed. RESULTS: Alzheimer's patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%). CONCLUSIONS: After taking into account the influence of age, Alzheimer's patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality. CLINICAL RELEVANCE: Clinicians should be aware of the implications of Alzheimer's disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.

Propiedades psicométricas de una nueva versión abreviada del State-Trait Anxiety Inventory (STAI) para valorar el nivel de ansiedad en personas mayores / Psychometric properties of a new short version of the State-Trait Anxiety Inventory (STAI) for the assessment of anxiety in the elderly

Introducción: La ansiedad tiene efectos negativos sobre el rendimiento cognitivo y el ajuste psicosocial de las personas mayores. Dada la elevada prevalencia de los síntomas de ansiedad en personas con deterioro cognitivo, se ha indicado que podrían ser un marcador precoz de demencia. Una de las pruebas más utilizadas para valorar el nivel de ansiedad en personas mayores es el Inventario de Ansiedad Estado-Rasgo (STAI). No obstante, en la medida en que puede resultar una escala larga para los mayores, sería deseable contar con una versión abreviada de la misma. Métodos: Se reclutó una muestra de 489 participantes mayores de 68 años cognitivamente sanos, todos ellos eran voluntarios en un proyecto de investigación longitudinal sobre la enfermedad de Alzheimer (Proyecto Vallecas). La muestra se subdividió en 2 grupos homogéneos: el grupo A se utilizó para reducir el número de ítems y de opciones de respuesta, y el grupo B para obtener las propiedades psicométricas de la nueva escala reducida (STAIr). Resultados: Se empleó el modelo de Rasch dicotómico para obtener el STAIr. Las variables sociodemográficas no mostraron asociación con las puntuaciones de la nueva versión. Se estudiaron las propiedades psicométricas y se hallaron los datos normativos del STAIr. Conclusiones: La nueva versión STAIr se compone de 13 ítems y presenta una adecuada bondad psicométrica. En la medida en que es una escala rápida y sencilla para las personas mayores, su aplicación resulta útil en los contextos clínico e investigador

Introduction: Anxiety has negative effects on the cognitive performance and psychosocial adjustment of elderly people. Given the high prevalence of anxiety symptoms in patients suffering from cognitive impairment, it has been suggested that these symptoms may be an early marker of dementia. The State-Trait Anxiety Inventory (STAI) is one of the most widely-used scales for evaluating anxiety in elderly people. However, inasmuch as the STAI may be difficult to apply to older people, having a short form of it would be desirable. Methods: The participants comprised 489 community-dwelling individuals aged 68 years and over. All of them were volunteers in a longitudinal study for early detection of Alzheimer’ Disease (Proyecto Vallecas). The full sample was divided in two homogeneous subgroups: Group A, used to reduce the number of items and response options, and Group B, the group used to determine the psychometric properties of the new short form (STAIr). Results: A dichotomous Rasch model was used to obtain the STAIr. No statistically significant differences for STAIr scores were found with respect to sociodemographic variables. Psychometric properties and normative data were obtained for the new short version. Conclusions: The STAIr is composed of 13 items and data fits the model well. Since it is short and easy to apply to elderly people, STAIr will be very useful in clinical and research settings

Psychometric properties of a new short version of the State-Trait Anxiety Inventory (STAI) for the assessment of anxiety in the elderly.

INTRODUCTION: Anxiety has negative effects on the cognitive performance and psychosocial adjustment of elderly people. Given the high prevalence of anxiety symptoms in patients suffering from cognitive impairment, it has been suggested that these symptoms may be an early marker of dementia. The State-Trait Anxiety Inventory (STAI) is one of the most widely-used scales for evaluating anxiety in elderly people. However, inasmuch as the STAI may be difficult to apply to older people, having a short form of it would be desirable. METHODS: The participants comprised 489 community-dwelling individuals aged 68 years and over. All of them were volunteers in a longitudinal study for early detection of Alzheimer' Disease (Proyecto Vallecas). The full sample was divided in two homogeneous subgroups: Group A, used to reduce the number of items and response options, and Group B, the group used to determine the psychometric properties of the new short form (STAIr). RESULTS: A dichotomous Rasch model was used to obtain the STAIr. No statistically significant differences for STAIr scores were found with respect to sociodemographic variables. Psychometric properties and normative data were obtained for the new short version. CONCLUSIONS: The STAIr is composed of 13 items and data fits the model well. Since it is short and easy to apply to elderly people, STAIr will be very useful in clinical and research settings.

Psychometric properties of the International Wellbeing Index in community-dwelling older adults.

BACKGROUND: This is the first study to analyze the psychometric properties of the International Wellbeing Index (IWI), which comprises the Personal Wellbeing Index (PWI) and National Wellbeing Index (NWI), among community-dwelling older adults. METHODS: The IWI was applied to 1106 community-dwelling adults aged 60 years and over. The sample was additionally assessed using scales for comorbidity, disability, mood, general orientation to life, social support, health-related quality of life, and two questions assessing satisfaction with life as a whole and with life in Spain. The PWI and NWI were separately analyzed for acceptability, internal consistency, convergent and discriminative validity, and precision. Linear regression analyses of the PWI and the NWI were also conducted. RESULTS: Mean scores were 71.0 ± 13.5 for the PWI and 49.5 ± 14.4 for the NWI. No floor or ceiling effects were detected. Cronbach's α was 0.88 for the PWI and 0.92 for the NWI. Factor analysis identified two factors in the IWI, and one factor in the PWI and NWI respectively. The PWI showed a correlation of 0.50 with the "satisfaction with life as a whole" item, and the NWI showed a correlation of 0.73 with the "satisfaction with life in Spain" item. There were significant differences in scores: in the PWI, according to gender, age, social support, education and depression; and in the NWI, according to education and depression. The regression model identified psychosocial, health and functional factors as determinants of the PWI (explained variance: 46.8%). CONCLUSIONS: The IWI displays good acceptability and is a consistent, valid and precise measure of global quality of life in older adults.

Assessing autonomic symptoms of Parkinson's disease with the SCOPA-AUT: a new perspective from Rasch analysis.

BACKGROUND: The Scale for Outcomes in Parkinson's disease (PD) for Autonomic Symptoms (SCOPA-AUT) is a specific scale to assess autonomic dysfunction in PD patients. It was developed and validated under the classic test theory approach. This study sought to test whether the SCOPA-AUT meets item response theory standards for reliability, internal construct validity, response category ordering, and differential item functioning by gender and age group. METHOD: The Rasch measurement model was applied to a sample of 385 PD patients. RESULTS: Model fit was obtained after the response categories were rescored and item 10-Incomplete emptying deleted because of redundancy. Person separation index, a reliability measure, was 0.82. All but two items (2-Sialorrhea and 13-Nocturia) were free of gender- and age-related bias. The strict tests of unidimensionality were met, indicating the validity of the total sumscore. Scale targeting suggested the need for items representing milder autonomic symptoms. CONCLUSIONS: Suggestions for improving the SCOPA-AUT include a shorter scale with a simpler response scheme and a combination of sexual items for men and women. The resulting SCOPA-AUT is a reliable scale, with good internal construct validity, providing Rasch transformed results on a linear metric scale.

Independent validation of the scales for outcomes in Parkinson's disease-autonomic (SCOPA-AUT).

BACKGROUND AND PURPOSE: Autonomic dysfunction is common in Parkinson's disease (PD) and causes a great impact in health-related quality of life (HRQL) and functional status of patients. This study is the first independent validation of the Scales for Outcomes in PD-Autonomic (SCOPA-AUT). METHODS: In an observational, cross-sectional study (ELEP Study), 387 PD patients were assessed using, in addition to the SCOPA-AUT, the Hoehn and Yahr staging, SCOPA-Motor, SCOPA-Cognition, Cumulative Illness Rating Scale-Geriatrics, modified Parkinson Psychosis Rating Scale, Clinical Impression of Severity Index for PD, Hospital Anxiety and Depression Scale, SCOPA-Sleep, SCOPA-Psychosocial, pain and fatigue visual analogue scales, and EQ-5D. SCOPA-AUT acceptability, internal consistency, construct validity, and precision were explored. RESULTS: Data quality was satisfactory (97%). SCOPA-AUT total score did not show floor or ceiling effect, and skewness was 0.40. Cronbach's alpha coefficients ranged from 0.64 (Cardiovascular and Thermorregulatory subscales) to 0.95 (Sexual dysfunction, women). Item homogeneity index was low (0.24) for Gastrointestinal subscale. Factor analysis identified eight factors for men (68% of the variance) and seven factors for women (65% of the variance). SCOPA-AUT correlated at a high level with specific HRQL and functional measures (r(S) = 0.52-0.56). SCOPA-AUT scores were higher for older patients, for more advanced disease, and for patients treated only with levodopa (Kruskal-Wallis test, P < 0.01). Standard error of measurement for SCOPA-AUT subscales was 0.81 (sexual, men) - 2.26 (gastrointestinal). CONCLUSIONS: Despite its heterogeneous content, which determines some weaknesses in the psychometric attributes of its subscales, SCOPA-AUT is an acceptable, consistent, valid and precise scale.

Should the SCOPA-COG be modified? A Rasch analysis perspective.

BACKGROUND AND PURPOSE: The SCales for Outcomes in PArkinson's disease-Cognition (SCOPA-COG) is a specific measure of cognitive function for Parkinson's disease (PD) patients. Previous studies, under the frame of the classic test theory, indicate satisfactory psychometric properties. The Rasch model, an item response theory approach, provides new information about the scale, as well as results in a linear scale. This study aims at analysing the SCOPA-COG according to the Rasch model and, on the basis of results, suggesting modification to the SCOPA-COG. METHOD: Fit to the Rasch model was analysed using a sample of 384 PD patients. RESULTS: A good fit was obtained after rescoring for disordered thresholds. The person separation index, a reliability measure, was 0.83. Differential item functioning was observed by age for three items and by gender for one item. CONCLUSIONS: The SCOPA-COG is a unidimensional measure of global cognitive function in PD patients, with good scale targeting and no empirical evidence for use of the subscale scores. Its adequate reliability and internal construct validity were supported. The SCOPA-COG, with the proposed scoring scheme, generates true linear interval scores.

[The current state of the art concerning quality of life in Parkinson's disease: II. Determining and associated factors]. / Situación actual del conocimiento sobre calidad de vida en la enfermedad de Parkinson: II. Determinantes y factores asociados.

INTRODUCTION: Health-related quality of life (HRQL) in Parkinson's disease (PD) is an area that is receiving a growing amount of interest as the new biopsychosocial model of medicine is adopted. AIM. This paper is the second part of a review of the current state of the art concerning HRQL in PD and focuses on its main determining and associated factors. DEVELOPMENT: A total of 56 studies are reviewed and the determining factors are grouped according to different variables, which may be disease-related (including motor and non-motor symptoms), sociodemographic (level of schooling, economic factors, gender and others), psychological and related to mental status (depression, anxiety, cognitive impairment, physician-patient relationship and others), and disability. The following characteristics of the studies were taken into account: the type of design (longitudinal or cross-sectional), the instrument used for measuring the HRQL (generic or specific), the statistical method employed (univariate or multivariate) and the sample size. CONCLUSIONS: Most of the studies are cross-sectional and the majority use the 39-item Parkinson's Disease Questionnaire as a measure of HRQL with multivariate data analysis. The three most important factors determining HRQL in PD are depression, the stage of the disease and the time elapsed since onset of the disease. Nevertheless, the preferred methodology does not allow for causal inferences, due to the scarcity of longitudinal studies.

Situación actual del conocimiento sobre calidad de vida en la enfermedad de Parkinson: I. Instrumentos, estudios comparativos y tratamientos / The current state of the art concerning queality of life in parkinson´s disease: I. Instruments, comparative studies and treatments

Resumen. Introducción. En la última década, ha aumentado gradualmente el interés por el estudio del impacto de la enfermedad de Parkinson (EP) en la calidad de vida relacionada con la salud (CVRS) de los pacientes. Se han desarrollado instrumentos específicos para su medición que, junto con medidas de CVRS genéricas, se aplican frecuentemente en la actualidad en los ensayos clínicos y otros estudios. Esta revisión forma parte de una serie de dos artículos cuyo objetivo es describir la situación actual de los estudios de la CVRS en la EP y detectar lagunas en el conocimiento que puedan orientar a los investigadores para futuros proyectos. Objetivo. Revisar los conceptos, instrumentos, estudios comparativos y efecto de los tratamientos sobre la CVRS de los pacientes con EP. Desarrollo. Se presentan conceptos fundamentales sobre CVRS y se describen los instrumentos para su medición. También se describen los principales hallazgos en cuanto a estudios comparativos sobre la CVRS de pacientes con EP. Finalmente, se revisa el efecto de los tratamientos sobre la CVRS, incluyendo las terapias alternativas. Conclusiones. A pesar de los grandes avances en este terreno, se requieren más estudios con metodología rigurosa y aportación de datos longitudinales (AU)

Summary. Introduction. Over the last decade there has been growing interest in the study of the impact of Parkinson’s disease (PD) on the health-related quality of life (HRQL) of patients. Specific instruments have been developed to measure it and today these are frequently applied, together with generic measurements of HRQL, in clinical trials and other studies. This review is part of a series of two papers, the aim of which is to describe the current situation of studies on HRQL in PD and to detect areas in which knowledge is lacking, as a possible guide to researchers in future projects. Aim. To review the concepts, instruments, comparative studies and the effect of treatments on the HRQL of patients with PD. Development. The fundamental concepts of HRQL and the instruments used to measure it are described. The main findings as regards comparative studies about the HRQL of patients with PD are also outlined. Finally, the article examines the effect of treatments on HRQL, including alternative therapies. Conclusions. Despite the significant progress being made in this field, further studies with a rigorous methodology and longitudinal data are needed

[The current state of the art concerning quality of life in Parkinson's disease: I. Instruments, comparative studies and treatments]. / Situación actual del conocimiento sobre calidad de vida en la enfermedad de Parkinson: I. Instrumentos, estudios comparativos y tratamientos.

INTRODUCTION: Over the last decade there has been growing interest in the study of the impact of Parkinson's disease (PD) on the health-related quality of life (HRQL) of patients. Specific instruments have been developed to measure it and today these are frequently applied, together with generic measurements of HRQL, in clinical trials and other studies. This review is part of a series of two papers, the aim of which is to describe the current situation of studies on HRQL in PD and to detect areas in which knowledge is lacking, as a possible guide to researchers in future projects. AIM: To review the concepts, instruments, comparative studies and the effect of treatments on the HRQL of patients with PD. DEVELOPMENT: The fundamental concepts of HRQL and the instruments used to measure it are described. The main findings as regards comparative studies about the HRQL of patients with PD are also outlined. Finally, the article examines the effect of treatments on HRQL, including alternative therapies. CONCLUSIONS: Despite the significant progress being made in this field, further studies with a rigorous methodology and longitudinal data are needed.

[Psychometric attributes of the Parkinson's Disease-Cognitive Rating Scale. An independent validation study]. / Atributos psicométricos de la Parkinson's Disease-Cognitive Rating Scale. Estudio de validación independiente.

AIM: To perform an independent evaluation of the psychometric attributes of the Parkinson's Disease-Cognitive Rating Scale (PD-CRS). PATIENTS AND METHODS: The study involved patients with Parkinson's disease (PD) free of any impediments preventing them from participating in the required evaluation. Sociodemographic and historical data were collected for use in this observational, cross-sectional study and the following evaluations were employed: Scales for Outcomes in Parkinson's Disease-Motor Scale (SCOPA-Motor), Hoehn and Yahr staging (HY), Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD), Minimental State Examination (MMSE), SCOPA-Cognitive (SCOPA-Cog), Non-Motor Symptoms Questionnaire and PD-CRS. Acceptability, internal consistence, construct validity and precision of the PD-CRS were analysed. RESULTS: The sample consisted of 50 patients, with a mean age of 63.6 +/- 9.3 years. In all, 66% were males, with a history of 9 +/- 5.7 years with PD, in HY stages 1 to 4. Twelve patients (24%) presented data suggestive of dementia. The PD-CRS score was: sub-cortical sub-scale: 60.9 +/- 16.5; cortical sub-scale: 27.9 +/- 4.4; and total PD-CRS: 88.7 +/- 19.8. The mean-median difference was < 10% of the maximum scores and the total score showed no ceiling or floor effect. Cronbach's alpha was 0.85; the item-total correlations ranged from 0.57 (naming) to 0.73 (working memory), and the homogeneity index of the items was 0.36. Correlation with the MMSE and the SCOPA-Cog was high (rS = 0.53 and 0.77). The PD-CRS score was significantly lower in patients with a low level of schooling and more severe PD according to levels on the CISI-PD and distinguished between patients with and without dementia (70.3 +/- 26.2 versus 94.5 +/- 13; p < 0.001. The standard error of the measurement was 1.98. CONCLUSIONS: The levels of acceptability, internal consistence, construct validity and precision displayed by the PD-CRS were satisfactory.

Atributos psicométricos de la Parkinson’s Disease-Cognitive Rating Scale. Estudio de validación independiente / Psychometric Attriutes of the Parkinson´s disease-cognitive rating scale. An independent validation study

Objetivo. Realizar una evaluación independiente de los atributos psicométricos de la Parkinson’s Disease-CognitiveRating Scale (PD-CRS). Pacientes y métodos. Pacientes con enfermedad de Parkinson (EP) sin impedimentos para la evaluaciónrequerida. Estudio observacional, transversal, con captación de datos sociodemográficos, históricos y las siguientes evaluaciones:Scales for Outcomes in Parkinson’s Disease-Escala motora (SCOPA-Motor), estadios de Hoehn y Yahr (HY), ClinicalImpression of Severity Index for Parkinson’s Disease (CISI-PD), Minimental State Examination (MMSE), SCOPA-Cognitive(SCOPA-Cog), Non-Motor Symptoms Questionnare y PD-CRS. Se analizaron la aceptabilidad, consistencia interna, validezde constructo y precisión de la PD-CRS. Resultados. Se incluyeron 50 pacientes, con una edad media de 63,6 ± 9,3 años.El 66% eran hombres, con 9 ± 5,7 años de duración de la EP, en estadio 1 a 4 de HY. Doce pacientes (24%) presentaban datossugerentes de demencia. La puntuación de la PD-CRS fue: subescala subcortical: 60,9 ± 16,5; subescala cortical: 27,9 ±4,4; y PD-CRS total: 88,7 ± 19,8. La diferencia media-mediana fue < 10% de las puntuaciones máximas, y la puntuación totalno presentó efecto suelo ni techo. El alfa de Cronbach fue de 0,85; las correlaciones ítem-total, de 0,57 (denominación) a0,73 (memoria de trabajo), y el índice de homogeneidad de los ítems, de 0,36. La correlación con el MMSE y la SCOPA-Cogfue alta (rS = 0,53 y 0,77). La puntuación de la PD-CRS fue significativamente menor en pacientes con bajo nivel educativo ymayor gravedad de la EP según niveles de la CISI-PD, y discriminó entre pacientes dementes y no dementes (70,3 ± 26,2 frentea 94,5 ± 13; p < 0,001). El error estándar de la medida fue de 1,98. Conclusión. La PD-CRS mostró aceptabilidad, consistenciainterna, validez de constructo y precisión satisfactorias (AU)

Aim. To perform an independent evaluation of the psychometric attributes of the Parkinson’s Disease-CognitiveRating Scale (PD-CRS). Patients and methods. The study involved patients with Parkinson’s disease (PD) free of any impedimentspreventing them from participating in the required evaluation. Sociodemographic and historical data were collected for use inthis observational, cross-sectional study and the following evaluations were employed: Scales for Outcomes in Parkinson’sDisease-Motor Scale (SCOPA-Motor), Hoehn and Yahr staging (HY), Clinical Impression of Severity Index for Parkinson’sDisease (CISI-PD), Minimental State Examination (MMSE), SCOPA-Cognitive (SCOPA-Cog), Non-Motor Symptoms Questionnaireand PD-CRS. Acceptability, internal consistence, construct validity and precision of the PD-CRS were analysed. Results. Thesample consisted of 50 patients, with a mean age of 63.6 ± 9.3 years. In all, 66% were males, with a history of 9 ± 5.7 yearswith PD, in HY stages 1 to 4. Twelve patients (24%) presented data suggestive of dementia. The PD-CRS score was: subcorticalsub-scale: 60.9 ± 16.5; cortical sub-scale: 27.9 ± 4.4; and total PD-CRS: 88.7 ± 19.8. The mean-median differencewas < 10% of the maximum scores and the total score showed no ceiling or floor effect. Cronbach’s alpha was 0.85; the itemtotalcorrelations ranged from 0.57 (naming) to 0.73 (working memory), and the homogeneity index of the items was 0.36.Correlation with the MMSE and the SCOPA-Cog was high (rS = 0.53 and 0.77). The PD-CRS score was significantly lower inpatients with a low level of schooling and more severe PD according to levels on the CISI-PD and distinguished betweenpatients with and without dementia (70.3 ± 26.2 versus 94.5 ± 13; p < 0.001. The standard error of the measurement was1.98. Conclusions. The levels of acceptability, internal consistence, construct validity and precision displayed by the PD-CRSwere satisfactory (AU)

[Psychometric attributes of the Scales for Outcomes in Parkinson's Disease-Psychosocial (SCOPA-PS): validation in Spain and review]. / Atributos psicométricos de la Scales for Outcomes in Parkinson's Disease-Psychosocial (SCOPA-PS): validación en España y revisión.

AIMS: To evaluate the psychometric attributes of the Scales for Outcomes in Parkinson's Disease-Psychosocial (SCOPA-PS) in Spain and to compare them with previous studies. PATIENTS AND METHODS: We performed a multi-centre, cross-sectional study of 387 patients with Parkinson's disease (PD), 70% of whom were in Hoehn and Yahr (HY) stages 2 or 3, with a mean age of 65.8 +/- 11.1 years and 8.1 +/- 6 years' progression. The following measures were applied: SCOPA-Motor, SCOPA-Cognition, modified Parkinson's Psychosis Rating Scale, Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD), Cumulative Illness Rating Scale-Geriatrics, SCOPA-Autonomic, SCOPA-Sleep, Hospital Anxiety and Depression Scale (HADS), Fatigue and Pain Visual Analogue Scales, EQ-5D and SCOPA-PS. Acceptability, internal consistence, dimensionality, construct validity and precision of the SCOPA-PS were analysed. RESULTS: The SCOPA-PS summary index displayed no ceiling or floor effect. Internal consistence was satisfactory (alpha = 0.85; item-total correlation => 0.39). Two factors were identified (53.5% of the variance). The SCOPA-PS was highly correlated (r(S) => 0.5) with the HADS, SCOPA-Motor, SCOPA-Automatic and EQ-5D index, and moderately so (r(S) = 0.35-0.49) with CISI-PD, fatigue and HY. The SCOPA-PS discriminated significantly between patients grouped according to HY stages, levels of severity of the CISI-PD, age groups and length of time with PD. The standard error of the measure was 7.24 +/- 18.7. As a whole, these findings are in agreement with previous studies. CONCLUSIONS: The SCOPA-PS is a scale with a satisfactory degree of acceptability, and it is consistent, valid and precise for evaluating the psychosocial impact of PD.

[Psychometric attributes of Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog), Castilian language]. / Atributos psicométricos de la Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog), versión en Castellano.

AIM: To test the psychometric attributes of the Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog), in Castilian language. PATIENTS AND METHODS: It is a multicenter, cross-sectional study carried out on 387 Parkinson's disease (PD) patients. They were 70% in Hoehn and Yahr stages 2 or 3; their mean age was 65,8 years and they underwent the disease for 8,1 years. Rater-based -SCOPA-Motor, modified Parkinson's Psychosis Rating Scale, Clinical Impression of Severity Index for PD (CISI-PD), Cumulative Illness Rating Scale-Geriatrics- and self-administered -SCOPA-Autonomic, SCOPA-Sleep, SCOPA-Psychosocial, Hospital Anxiety and Depression Scale, EuroQoL- assessments were applied. For SCOPA-Cog, the following psychometric attributes were analysed: acceptability, internal consistency, dimensionality, construct validity, and precision. A cut-off point for dementia and SCOPA-Cog score's predictors were explored. RESULTS: SCOPA-Cog was free from floor and ceiling effect. The internal consistency was satisfactory (alpha = 0,83) and the item-total correlation resulted equal or upper than 0,45. Two factors were identified (52% of variance), one of them formed by 3 out of the 4 memory-related items. The correlation with other measures was weak (rS < 0,35), except for the CISI-PD's item 'cognitive state' (rS = 0,51). SCOPA-Cog scored significantly different for Hoehn and Yahr stages and for patients grouped by age, age at onset of PD, and education. The standard error of measurement was 3,02. A cut-off point 19/20 reached 76% sensitivity and specificity for dementia. Age and age at onset of PD resulted the strongest predictors. CONCLUSION: SCOPA-Cog is a consistent, valid, and precise measure for assessment of the cognitive disorder in PD.

[A pilot study on a specific measure for sleep disorders in Parkinson's disease: SCOPA-Sleep]. / Estudio piloto sobre una medida especifica para los trastornos del sueno de la enfermedad de Parkinson: SCOPA-sueño.

INTRODUCTION: There is a high prevalence of sleep disorders in Parkinson's disease (PD). AIMS. To assess some basic metric attributes of the SCOPA-Sleep scale, a measure for PD patients; secondary objective: to check the impact caused by the sleep disorder on the health-related quality of life (HRQoL) of patients and their caregivers. SUBJECTS AND METHODS: 68 PD patients and their main caregivers; measures: Hoehn and Yahr staging, SCOPA-Motor, Clinical Impression of Severity Index (CISI-PD), PDSS, Hospital Anxiety and Depression Scale, SCOPA-Psychosocial, and EuroQoL. Carers filled in a PDSS questionnaire about patient sleep and HRQoL measures (SF-36, EuroQoL). SCOPA-Sleep acceptability, scaling assumptions, internal consistency, construct validity and precision were determined. RESULTS: SCOPA-Sleep acceptability and scaling assumptions resulted satisfactory, although the nocturnal sleep subescale (SC-Ns) showed a mild ceiling effect (22.1%) and a defective convergent validity was found for daytime sleepiness (SC-Ds) item 6. Internal consistency also was satisfactory for both scales (alpha = 0.84 and 0.75, respectively). The correlation between SC-Ns and PDSS was high (rs = -0.70), as it was between SC-Ns and PDSS questionnaire by caregiver (rs = -0.53). The corresponding coefficients with the SC-Ds gained lower values (rs = -0.41 y -0.50). Standard error of measurement was 1.45 for the SC-Ns and 1.76 for the SC-Ds. Both, patient and caregiver HRQoL showed a loose association with the sleep measures. CONCLUSION: SCOPA-Sleep is a feasible, consistent, and useful scale for assessment of sleep disorder in PD patients. A weak association between sleep disorder and HRQoL was found.

Estudio piloto sobre una medida específica para los trastornos del sueño de la enfermedad de Parkinson: SCOPA-sueño / A pilot study on a specific measure for sleep disorders in parkinson's disease: scopa-sleep

Introducción. En la enfermedad de Parkinson (EP) existe una alta prevalencia de trastornos del sueño. Objetivos. Comprobar los atributos métricos básicos de la escala SCOPA-sueño para pacientes con EP; objetivo secundario: analizar el impacto del trastorno del sueño en la calidad de vida relacionada con la salud(CVRS) del paciente y de su cuidador principal. Sujetos y métodos. 68 pacientes con EP y sus cuidadores principales. Se aplicaron: Hoehn y Yahr, SCOPA-motor, impresión clínica de gravedad (CISIPD),escala PDSS, Hospital Anxiety and Depression Scale, SCOPA-psicosocial y EuroQoL. El cuidador cumplimentó un cuestionario PDSS sobre el sueño del paciente y las medidas de la CVRS(SF-36, EuroQoL). Se analizaron la aceptabilidad, las asunciones escalares, la consistencia interna, la validez de constructo y la precisión de la SCOPA-sueño. Resultados. La SCOPA-sueño mostró aceptabilidad satisfactoria y asunciones escalares. La subescala sueño nocturno (SC-Sn) presentó leve efecto techo (22,1%), y la subescala somnolencia diurna (SC-Sd), defectuosa validez convergente del ítem 6; la consistencia interna de ambas resultó satisfactoria(alfa = 0,84 y 0,75, respectivamente). SC-Sn correlacionó significativamente con la PDSS (rS= –0,70) y con el cuestionario PDSS cumplimentado por el cuidador (rS= –0,53), y fueron menores los valores respectivos para la SC-Sd (rS= –0,41 y –0,50). Error estándar de la medida: SC-Sn, 1,45; SC-Sd, 1,76. La CVRS del pacientey la del cuidador mostraron una escasa correlación con las medidas de sueño. Conclusiones. La escala SCOPA-sueño es viable, consistente y útil para evaluar el trastorno del sueño en pacientescon EP. La relación entre la CVRS y la alteración del sueño fue débil

Introduction. There is a high prevalence of sleep disorders in Parkinson’s disease (PD). Aims. To assess some basicmetric attributes of the SCOPA-Sleep scale, a measure for PD patients; secondary objective: to check the impact caused by thesleep disorder on the health-related quality of life (HRQoL) of patients and their caregivers. Subjects and methods. 68 PDpatients and their main caregivers; measures: Hoehn and Yahr staging, SCOPA-Motor, Clinical Impression of Severity Index(CISI-PD), PDSS, Hospital Anxiety and Depression Scale, SCOPA-Psychosocial, and EuroQoL. Carers filled in a PDSSquestionnaire about patient sleep and HRQoL measures (SF-36, EuroQoL). SCOPA-Sleep acceptability, scaling assumptions,internal consistency, construct validity and precision were determined. Results. SCOPA-Sleep acceptability and scalingassumptions resulted satisfactory, although the nocturnal sleep subescale (SC-Ns) showed a mild ceiling effect (22.1%) and adefective convergent validity was found for daytime sleepiness (SC-Ds) item 6. Internal consistency also was satisfactory forboth scales (alpha = 0.84 and 0.75, respectively). The correlation between SC-Ns and PDSS was high (rS = –0.70), as it wasbetween SC-Ns and PDSS questionnaire by caregiver (rS = –0.53). The corresponding coefficients with the SC-Ds gainedlower values (rS = –0.41 y –0.50). Standard error of measurement was 1.45 for the SC-Ns and 1.76 for the SC-Ds. Both,patient and caregiver HRQoL showed a loose association with the sleep measures. Conclusion. SCOPA-Sleep is a feasible,consistent, and useful scale for assessment of sleep disorder in PD patients. A weak association between sleep disorder andHRQoL was found

[Neuropsychological disorders in Parkinson's disease: evaluating them and their impact on the caregiver]. / Alteraciones neuropsicológicas en la enfermedad de Parkinson: evaluación e impacto sobre el cuidador.

INTRODUCTION: There are no specific scales for evaluating the broad profile of potentially relevant neuropsychological disorders associated to Parkinson's disease. Moreover, the information about their impact on the quality of life of caregivers (QLC) is scarce. OBJECTIVES: This study outlines a model of a practical questionnaire developed to evaluate the neuropsychological disorders in Parkinson's disease and how to apply it to determine the effect they have on the QLC. PATIENTS AND METHODS: A study was performed in two phases: 1. The application of a list of items from several scales used for neuropsychological disorders; 2. After selecting and reducing the number of items by means of psychometric methods, they were applied to a sample of patients. At the same time, using the data obtained from the above mentioned procedure, the impact of the neuropsychological disorders on the QLC was evaluated with the Glozman scale. RESULT: In Parkinson's disease some neuropsychological disorders are relatively frequent, unlike those observed in a control group (either because of their frequency or their intensity) and are significantly associated to other aspects of the disease. There was an overall deterioration of the QLC and this worsened significantly as PD progressed and the disability of the patient increased. With respect to the neuropsychological disorders, verbal communication (rS = -0.59), cognitive behavioural mental status (rS = -0.54) and depression (rS = -0.41) (p < 0.001) were the domains significantly linked to deterioration of the QLC. CONCLUSIONS: The QLC of patients with Parkinson's disease is decreased and is correlated with the extent of the patient's motor disorders, functional status and neuropsychological disorders.

Enfermedad de Parkinson: cuantificación de la incapacidad basada en la Escala Unificada de Valoración de la Enfermedad de Parkinson / Parkinson's disease: quantification of disability based on the Unified Parkinson's Disease Rating Scale

OBJETIVOS: Explorar el desarrollo de una medida sencilla de la incapacidad producida por la enfermedad de Pakinson (EP). MÉTODOS: Pacientes: 65 pacientes ambulantes, en estadios 1 a 5 de la Clasificación de Hoehn y Yahr (HY). Evaluaciones: HY, escalas de Schwab and England, de incapacidad de la Northwestern University, de valoración de la Columbia University, de Webster, Índice de Barthel, finger tapping y "Up & Go" cronometrados. Se eligieron seis ítems, representativos de las actividades más básicas de la vida diaria (AVD), de la Sección AVD de la Unified Parkinson´s Disease Rating Scale para componer la puntuación de incapacidad de la UPDRS (PIU), que fue asignada simultáneamente por tres observadores. Se realizó una evaluación global de incapacidad por el paciente y por el médico. Análisis estadístico: Descriptivo, alfa de Cronbach, kappa de Fleiss, coeficiente de correlación de Spearman, prueba de Krustal-Wallis y análisis factorial. RESULTADOS: La consistencia interna (Alfa de Cronbach = 0,86-0,87) y la fiabilidad interobservador (kappa = 0,84-0,98) fueron satisfactorias. La validez convergentes del UDS con las escalas para EP (R= 0,76-0,92), evaluaciones globales (R=0,84-0,88) y test cronometrados (R=0,47-0,65) resultó muy significativa (todos, p < 0,001). La distribución de las puntuaciones de la PIU según los estadios de HY presentó tendencias significativas (Krustal-Wallis test, p<0,001). Se identificó un único factor que explicaba alrededor del 64 por ciento de la variancia. CONCLUSIÓN: De la UPDRS puede obtenerse una valoración sencilla y válida de la incapacidad debida a EP (AU)

Parkinson's disease: quantification of disability based on the Unified Parkinson's Disease Rating Scale.

OBJECTIVES: To develop a simple measure for quantification of the disability (dependency) due to Parkinson's disease (PD). PATIENTS: 65 nondemented PD outpatients, stage 1 to 5 of the Hoehn and Yahr Classification (HY). ASSESSMENT: HY, Schwab and England Scale, Northwestern University Disability Scale, Columbia University Rating Scale, Webster Scale, Barthel's Index, finger tapping, and timed "Up & Go" test. Six items from the ADL Section of the Unified PD Rating Scale (UPDRS)--as representative of the most basic ADL--were chosen to compose the UPDRS disability score (UDS), that was simultaneously rated by three observers. Global evaluations of disability by patient and physician were also recorded. STATISTICS: Descriptive, Cronbach alpha, kappa of Fleiss, Spearman rank correlation coefficients, Kruskal-Wallis test, and factor analysis. RESULTS: Internal consistency (Cronbach alpha = 0.86-0.87) and interobserver reliability (kappa = 0.84-0.98) were satisfactory. Convergent validity of the UDS with the applied PD rating scales (R = 0.76-0.92), global evaluations (R = 0.84-0.88), and timed tests (R = 0.47-0.65) was highly significant (all, p < 0.001). Distribution of UDS values across the HY categories showed significant trends (Kruskal-Wallis test, p < 0.001). A single factor explaining over 64% of the variance was identified. CONCLUSION: A simple and valid instrument for standardized evaluation of disability in PD is embedded in the UPDRS.