Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado / Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests

Objetivo: Estimar la prevalencia de deterioro cognitivo (DC) en ancianos de la comunidad. Evaluar el rendimiento diagnóstico de los principales test de cribado cognitivo usados en atención primaria: miniexamen cognoscitivo (MEC), test del reloj (TR), test de fluencia verbal (TFV) y test del informador (TIN). Calcular la concordancia entre ellos y su validez como pruebas de cribado. Diseño: Estudio descriptivo transversal. Participantes: Doscientos noventa y tres personas de ambos sexos, mayores de 64 años, residentes en la provincia de Huesca, seleccionados mediante muestreo aleatorizado sistemático. Marco muestral: base de datos de Tarjeta Sanitaria Individual. Ámbito provincial. Mediciones: Variables sociodemográficas básicas, y exploración del DC con MEC, TR, TFV y TIN. Resultados: En función del MEC y los diagnósticos previos, la prevalencia de DC es del 18,1% (IC del 95%: del 15,3 al 24,4%). Resultados: La concordancia del MEC con el resto de los test de cribado es moderada: con el TR kappa (κ)=0,40, con el de TFV: 0,33, con el TIN: 0,36. Resultados: La concordancia global del conjunto de los test cognitivos es moderada-baja: κ (Jackknife)=0,35 (IC del 95%: 0,269 a 0,444). Resultados: Considerando patrón de oro al MEC junto con el diagnóstico previo de DC, el TR presenta una sensibilidad del 78,3% y una especificidad del 76,9%; el TFV presenta el 80 y el 70%, respectivamente, y el TIN presenta el 76,7 y el 71,4%, respectivamente. El área bajo la curva ROC (receiver operating characteristics) del TFV es significativamente superior al resto. Conclusión: La concordancia entre los distintos test de cribado cognitivo es moderada. El TFV es el que mejor rendimiento diagnóstico presenta (AU)

Objective: To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. Design: Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. Participants: A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. Participants: Main measurementsWe analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. Results: The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3–24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. Conclusions: The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy (AU)

[Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests]. / Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado.

OBJECTIVE: To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. DESIGN: Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. PARTICIPANTS: A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. MAIN MEASUREMENTS: We analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. RESULTS: The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3-24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. CONCLUSIONS: The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy.

[Screening for factors relating to the development of mental disorders in the geriatric population (PSICOTARD)]. / Detección de factores relacionados con el desarrollo de trastornos mentales en la población geriátrica (PSICOTARD).

OBJECTIVES: To detect the physical, psychological, social-demographic, and functional factors that may involve risk of developing mental disorder in the elderly, to determine the magnitude of each factor and to do the groundwork for a future longitudinal study that will enable us to define the elderly with psychological fragility in the autonomous region and to design predictive models for mental deterioration in the elderly. DESIGN: Descriptive study based on personal interviews by professionals using a standardised method. SETTING: Twenty-eight primary care health centres in the province of Huesca, Spain, with an ageing rate over 24.6%. PARTICIPANTS: Three-hundred and twenty-six patients over 64 years and resident in the province of Huesca, Spain. INTERVENTION: Personal interview conducted by health professionals (30 family doctors and a trainee psychologist). The following will be appraised: the presence of cognitive impairment (Mini-Mental State Examination), depression (Yesavage Geriatric Depression Scale), anxiety (Goldberg Scale of Anxiety), and presence of delusions, hallucinations, obsessions and hypochondria (Geriatric Mental State-GMS). MAIN MEASUREMENTS: The prevalence of the risk factors will be calculated: social and demographic variables (age, sex, marital status, education, living alone), functional status (Barthel index), the severity of physical disability (Cumulative Illness Rating Scale), pathological records (somatic and psychological), and stressful life events in the preceding year. A logistical regression model will be calculated to determine the weight of the effect of each factor adjusted for all the rest. Individual risk will be calculated for the development of each mental disorder (depression, anxiety, cognitive deterioration/dementia, psychotic symptoms, obsessions). DISCUSSION: The reliability of the questionnaire is ensured by use of diagnostic tests of proven validity and reliability, prior training of researchers and use of a data-gathering pilot study.

Detección de factores relacionados con el desarrollo de trastornos mentales en la población geriátrica (PSICOTARD) / Screening for factors relating to the development of mental disorders in the geriatric population (PSICOTARD)

Objetivos. Detectar factores físicos, psíquicos, sociodemográficos y funcionales asociados con el desarrollo de trastornos mentales en los ancianos, determinar su magnitud, estimar el riesgo individual y preparar el terreno para un posterior estudio longitudinal que nos permita en el futuro definir el anciano con fragilidad psíquica en la comunidad y el diseño de modelos predictivos de deterioro mental en el anciano. Diseño. Estudio descriptivo mediante entrevistas personales realizadas por profesionales estandarizados. Emplazamiento. En total, 28 centros de salud de la provincia de Huesca (índice de envejecimiento > 24,6%). Participantes. Participarán 326 personas mayores de 64 años residentes en la provincia de Huesca (España). Intervención. Entrevista personal por profesionales estandarizados (30 médicos de familia y un becario psicólogo). Se valorará la presencia de deterioro cognitivo (Mini-Examen Cognoscitivo), depresión (Escala de depresión geriátrica de Yesavage), ansiedad (Subescala de ansiedad del test de Goldberg) y alucinaciones, ideas delirantes, obsesiones e ideas hipocondríacas (Geriatric Mental State-GMS). Mediciones principales. Se estimará la prevalencia de factores de riesgo: variables sociodemográficas (edad, sexo, estado civil, nivel educativo, convivencia), situación funcional (índice de Barthel), gravedad física (índice acumulativo de enfermedad), antecedentes patológicos (somáticos y psíquicos) y acontecimientos vitales estresantes en el último año. Se ajustará un modelo de regresión logística para determinar la magnitud del efecto de cada factor ajustado para todos los demás. Se estimará el riesgo individual para el desarrollo de cada enfermedad (depresión, ansiedad, deterioro cognitivo/demencia, síntomas psicóticos, ideas obsesivas). Discusión. La fiabilidad del cuestionario se garantiza con el empleo de tests diagnósticos de comprobada validez y fiabilidad, la estandarización de los investigadores y la realización de un pilotaje del cuaderno de recogida de datos

Objectives. To detect the physical, psychological, social-demographic, and functional factors that may involve risk of developing mental disorder in the elderly, to determine the magnitude of each factor and to do the groundwork for a future longitudinal study that will enable us to define the elderly with psychological fragility in the autonomous region and to design predictive models for mental deterioration in the elderly. Design. Descriptive study based on personal interviews by professionals using a standardised method. Setting. Twenty-eight primary care health centres in the province of Huesca, Spain, with an ageing rate over 24.6%. Participants. Three-hundred and twenty-six patients over 64 years and resident in the province of Huesca, Spain. Intervention. Personal interview conducted by health professionals (30 family doctors and a trainee psychologist). The following will be appraised: the presence of cognitive impairment (Mini-Mental State Examination), depression (Yesavage Geriatric Depression Scale), anxiety (Goldberg Scale of Anxiety), and presence of delusions, hallucinations, obsessions and hypochondria (Geriatric Mental State-GMS). Main measurements. The prevalence of the risk factors will be calculated: social and demographic variables (age, sex, marital status, education, living alone), functional status (Barthel index), the severity of physical disability (Cumulative Illness Rating Scale), pathological records (somatic and psychological), and stressful life events in the preceding year. A logistical regression model will be calculated to determine the weight of the effect of each factor adjusted for all the rest. Individual risk will be calculated for the development of each mental disorder (depression, anxiety, cognitive deterioration/dementia, psychotic symptoms, obsessions). Discussion. The reliability of the questionnaire is ensured by use of diagnostic tests of proven validity and reliability, prior training of researchers and use of a data-gathering pilot study