Utilidad diagnóstica de test cognitivos breves en el cribado de deterioro cognitivo / Diagnostic performance of brief cognitive tests in cognitive impairment screening

Introducción y objetivos: Evaluar y comparar la utilidad diagnóstica (UD) para el cribado de deterioro cognitivo (DC) de los test cognitivos breves (TCB) recomendados por la Guía de práctica clínica sobre la atención integral a las personas con enfermedad de Alzheimer y otras demencias. Material y métodos: Estudio de fase iii de evaluación de pruebas diagnósticas en el que se ha incluido en Atención Primaria a sujetos con sospecha de DC. A todos se les ha aplicado Mini-Mental State Examination (Mini-Mental), Mini Examen Cognoscitivo (MEC), Short Portable Mental Status Questionnaire (SPMSQ), Memory Impairment Screen (MIS), test del reloj (TdR), Eurotest, Fototest y test de alteración de memoria (T@M). El diagnóstico de DC se ha realizado de forma independiente y cegada con respecto a los resultados de los TCB. La UD se ha evaluado mediante el área bajo la curva ROC (aROC). Resultados: Se ha incluido a 141 sujetos (86 con DC). El Eurotest y el T@M (0,91 ± 0,02 [aROC ± EE] y 0,90 ± 0,02, respectivamente), los instrumentos que requieren más tiempo (7,1 ± 1,8 [media ± DE] y 6,8 ± 2,2 min, respectivamente) tienen una UD significativamente superior a la del Mini-Mental, MEC, SPMSQ y TdR, pero no a la del MIS y Fototest (0,87 ± 0,03 ambas), requiriendo este último menos de la mitad del tiempo (2,8 ± 0,8 min). T@M y MIS solo evalúan memoria y el último no es aplicable a analfabetos. Conclusiones: Los instrumentos más recomendables para el cribado de DC en Atención Primaria son Eurotest, T@M y Fototest, siendo el último más eficiente por requerir la mitad de tiempo. (AU)

Introduction and objectives: This study aims to assess and compare the diagnostic performance of brief cognitive tests for cognitive impairment (CI) screening recommended by the Spanish guidelines for the integral care of people with Alzheimer's disease and other dementias. Material and methods: We performed a phase iii study into the accuracy of diagnostic tests, including patients with suspected CI in a primary care setting. All patients completed the Mini–Mental State Examination (MMSE), the Mini Examen Cognoscitivo (MEC), the Short Portable Mental Status Questionnaire (SPMSQ), the Memory Impairment Screen (MIS), the Clock Drawing Test (CDT), the Eurotest, the Fototest, and the Memory Alteration Test (M@T). CI was diagnosed independently by researchers blinded to scores on these tests. Diagnostic performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC). Results: The study included 141 individuals (86 with CI). The Eurotest and M@T (AUC ± SE: 0.91 ± 0.02 and 0.90 ± 0.02, respectively) took longer to administer (mean [SD]: 7.1 [1.8] and 6.8 [2.2] min, respectively) and have significantly better diagnostic performance compared to the MMSE, MEC, SPMSQ, and CDT, but not compared to MIS or Fototest (both with an AUC of 0.87 ± 0.03), with the latter taking less than half as long to administer (2.8 [0.8] min). The M@T and MIS only evaluate memory, and the latter cannot be administered to illiterate people. Conclusion: The most advisable tests for CI screening in primary care are the Eurotest, M@T, and Fototest, with the latter being the most efficient as it takes half as long to administer. (AU)

Diagnostic performance of brief cognitive tests in cognitive impairment screening.

INTRODUCTION AND OBJECTIVES: This study aims to assess and compare the diagnostic performance of brief cognitive tests for cognitive impairment (CI) screening recommended by the Spanish guidelines for the integral care of people with Alzheimer's disease and other dementias. MATERIAL AND METHODS: We performed a phase iii study into the accuracy of diagnostic tests, including patients with suspected CI in a primary care setting. All patients completed the Mini-Mental State Examination (MMSE), the Mini Examen Cognoscitivo (MEC), the Short Portable Mental Status Questionnaire (SPMSQ), the Memory Impairment Screen (MIS), the Clock Drawing Test (CDT), the Eurotest, the Fototest, and the Memory Alteration Test (M@T). CI was diagnosed independently by researchers blinded to scores on these tests. Diagnostic performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC). RESULTS: The study included 141 individuals (86 with CI). The Eurotest and M@T (AUC±SE: 0.91±0.02 and 0.90±0.02, respectively) took longer to administer (mean [SD]: 7.1 [1.8] and 6.8 [2.2]min, respectively) and have significantly better diagnostic performance compared to the MMSE, MEC, SPMSQ, and CDT, but not compared to MIS or Fototest (both with an AUC of 0.87±0.03), with the latter taking less than half as long to administer (2.8 [0.8]min). The M@T and MIS only evaluate memory, and the latter cannot be administered to illiterate people. CONCLUSION: The most advisable tests for CI screening in primary care are the Eurotest, M@T, and Fototest, with the latter being the most efficient as it takes half as long to administer.

Normative data for the Fototest from neurological patients with no cognitive impairment.

OBJECTIVES: To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). MATERIAL AND METHODS: We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). RESULTS: We included a sample of 1055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ±â€¯5.3; P10: 28; P5: 27) and free recall (8.5 ±â€¯2.2; 6; 4), total recall (10.0 ±â€¯1.5; 8; 7), and naming fluency scores (18.7 ±â€¯4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ±â€¯0.3 (ß ±â€¯SD) for sex (female), -2.4 ±â€¯0.3 for age (>65), and -1.6 ±â€¯0.4 and 3.3 ±â€¯0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). CONCLUSIONS: We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting.

Evaluación de la utilidad diagnóstica y validez discriminativa del Test del Reloj y del Mini-Cog en la detección del deterioro cognitivo / Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment

Introducción y objetivos: El Mini-Cog es un test cognitivo muy breve de uso extendido que incluye una tarea de memoria y una evaluación simplificada del Test del Reloj (TdR). No existe una evaluación formal del Mini-Cog en español; nuestro objetivo es analizar la utilidad diagnóstica (UD) del Mini-Cog y del TdR para deterioro cognitivo (DC). Métodos: Estudio transversal en el que se han incluido de forma sistemática todos los sujetos atendidos durante un semestre en una consulta de Neurología. La UD se ha evaluado para DC (incluye sujetos con criterios NIA-AA de Mild Cognitive Impairment o demencia) por medio del área bajo la curva ROC (aROC). Se han calculado los parámetros de sensibilidad (S), especificidad (E) y cocientes de probabilidad positivo y negativo (CP+, CP−) para los distintos puntos de corte. Resultados: Se han incluido 581 sujetos (315 DC), 55,1% mujeres y 27,7% con bajo nivel educativo (< estudios primarios). La UD del Mini-Cog es superior a la del TdR (0,88 ± 0,01 (aROC ± EE) vs 0,84 ± 0,01, p < 0,01); para ambos instrumentos la UD disminuye notablemente en sujetos con bajo nivel educativo (0,74 ± 0,05 y 0,75 ± 0,05, respectivamente). El punto de corte 2/3 del Mini-Cog tiene una S de 0,90 (0,87-0,93) y una E de 0,71 (0,65-0,76) y el 5/6 del TdR una S de 0,77 (0,72-0,81) y una E de 0,80 (0,75-0,85). Conclusiones: En consulta de Neurología, el Mini-Cog tiene una UD para DC aceptable, superior a la del TdR; ninguno de ellos es un instrumento adecuado para ser utilizado en sujetos con bajo nivel educativo. (AU)

Introduction and objectives: The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI). Methods: We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point. Results: The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC ± sensitivity: 0.88 ± 0.01 vs 0.84 ± 0.01; P < .01). Both instruments were less useful for screening in individuals with a low education level (0.74 ± 0.05 vs 0.75 ± 0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95% CI, 0.87-0.93) and a specificity of 0.71 (95% CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95% CI, 0.72-0.81) and a specificity of 0.80 (95% CI, 0.75-0.85). Conclusion: In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education. (AU)

Valores normativos del Fototest en pacientes neurológicos sin deterioro cognitivo / Normative data for the Fototest from neurological patients with no cognitive impairment

Objetivos: Proporcionar valores normativos del Fototest relativos a pacientes neurológicos sin deterioro cognitivo, que incluyan datos desagregados para cada uno de los dominios que conforman este instrumento (denominación, recuerdo libre, recuerdo total y fluidez de nombres). Material y métodos: Estudio transversal en pacientes neurológicos sin deterioro cognitivo a los que se aplicó el Fototest, registrándose las puntuaciones desagregadas y total. Estudio descriptivo de los resultados totales y desagregados del Fototest estratificados por sexo, edad (< 65/> 65 años) y estudios (< primaria/primaria/> primaria). Resultados: Muestra de 1.055 sujetos con predominio de mujeres (57,1%), mayores de 65 años (60,6%) y con bajo nivel educativo (36,8% sin estudios primarios). La puntuación total del Fototest (34,6 ± 5,3; 28; 27 [media ± DE; P10; P5]), así como las desagregadas para denominación (5,9 ± 0,3; 6; 5), recuerdo libre (8,5 ± 2,2; 6; 4), recuerdo total (10,0 ± 1,5; 8; 7) y fluidez de nombres (18,7 ± 4,9; 13; 12), están influidas por el sexo, la edad y el nivel educativo. Para la puntuación total, los resultados del estudio multivariante son: sexo (mujer) 1,5 ± 0,3 (ß ± EE), edad (> 65 años) −2,4 ± 0,3, estudios < primaria −1,6 ± 0,4 y estudios > primaria 3,3 ± 0,4 (primaria = referencia estudios). Conclusión: Se proporcionan valores normativos (media ± DE, P10; P5) del Fototest para cada uno de los estratos definidos por las variables sexo, edad y estudios tanto para las puntuaciones totales como desagregadas del Fototest, así como una distribución percentual para cada uno de los valores posibles de estas puntuaciones. Estos valores normativos es de esperar que se traduzcan en una mayor eficiencia del Fototest en el ámbito clínico. (AU)

Objectives: To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). Material and methods: We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). Results: We included a sample of 1,055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ± 5.3; P10: 28; P5: 27) and naming (5,9±0,3; 6; 5), free recall (8.5 ± 2.2; 6; 4), total recall (10.0 ± 1.5; 8; 7), and naming fluency scores (18.7 ± 4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ± 0.3 (ß ± SE) for sex (female), −2.4 ± 0.3 for age (> 65), and −1.6 ± 0.4 and 3.3 ± 0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). Conclusion: We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting. (AU)

Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment.

INTRODUCTION AND OBJECTIVES: The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI). METHODS: We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point. RESULTS: The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC ±â€¯sensitivity: 0.88 ±â€¯0.01 vs 0.84 ±â€¯0.01; P < .01). Both instruments were less useful for screening in individuals with a low education level (0.74 ±â€¯0.05 vs 0.75 ±â€¯0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95% CI, 0.87-0.93) and a specificity of 0.71 (95% CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95% CI, 0.72-0.81) and a specificity of 0.80 (95% CI, 0.75-0.85). CONCLUSION: In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education.

Diagnostic performance of brief cognitive tests in cognitive impairment screening. / Utilidad diagnóstica de test cognitivos breves en el cribado de deterioro cognitivo.

INTRODUCTION AND OBJECTIVES: This study aims to assess and compare the diagnostic performance of brief cognitive tests for cognitive impairment (CI) screening recommended by the Spanish guidelines for the integral care of people with Alzheimer's disease and other dementias. MATERIAL AND METHODS: We performed a phase iii study into the accuracy of diagnostic tests, including patients with suspected CI in a primary care setting. All patients completed the Mini-Mental State Examination (MMSE), the Mini Examen Cognoscitivo (MEC), the Short Portable Mental Status Questionnaire (SPMSQ), the Memory Impairment Screen (MIS), the Clock Drawing Test (CDT), the Eurotest, the Fototest, and the Memory Alteration Test (M@T). CI was diagnosed independently by researchers blinded to scores on these tests. Diagnostic performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC). RESULTS: The study included 141 individuals (86 with CI). The Eurotest and M@T (AUC ± SE: 0.91 ± 0.02 and 0.90 ± 0.02, respectively) took longer to administer (mean [SD]: 7.1 [1.8] and 6.8 [2.2] min, respectively) and have significantly better diagnostic performance compared to the MMSE, MEC, SPMSQ, and CDT, but not compared to MIS or Fototest (both with an AUC of 0.87 ± 0.03), with the latter taking less than half as long to administer (2.8 [0.8] min). The M@T and MIS only evaluate memory, and the latter cannot be administered to illiterate people. CONCLUSION: The most advisable tests for CI screening in primary care are the Eurotest, M@T, and Fototest, with the latter being the most efficient as it takes half as long to administer.

Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment. / Evaluación de la utilidad diagnóstica y validez discriminativa del Test del Reloj y del Mini-Cog en la detección del deterioro cognitivo.

INTRODUCTION AND OBJECTIVES: The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI). METHODS: We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point. RESULTS: The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC±sensitivity: 0.88±0.01 vs 0.84±0.01; P<.01). Both instruments were less useful for screening in individuals with a low education level (0.74±0.05 vs 0.75±0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95%CI, 0.87-0.93) and a specificity of 0.71 (95%CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95%CI, 0.72-0.81) and a specificity of 0.80 (95%CI, 0.75-0.85). CONCLUSION: In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education.

Normative data for the Fototest from neurological patients with no cognitive impairment. / Valores normativos del Fototest en pacientes neurológicos sin deterioro cognitivo.

OBJECTIVES: To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). MATERIAL AND METHODS: We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). RESULTS: We included a sample of 1,055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ± 5.3; P10: 28; P5: 27) and naming (5,9±0,3; 6; 5), free recall (8.5 ± 2.2; 6; 4), total recall (10.0 ± 1.5; 8; 7), and naming fluency scores (18.7 ± 4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ± 0.3 (ß ± SE) for sex (female), -2.4 ± 0.3 for age (> 65), and -1.6 ± 0.4 and 3.3 ± 0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). CONCLUSION: We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting.

Evaluación de la utilidad diagnóstica de la versión española del cuestionario al informador «AD8» / Assessing the diagnostic accuracy (DA) of the spanish version of the informant-based AD8 questionnaire

Introducción: El AD8 es un cuestionario al informador breve que puede ser autoaplicado y facilita la identificación de deterioro cognitivo (DC); nuestro objetivo es evaluar la utilidad diagnóstica (UD) de una versión espa˜nola. Material y métodos: Estudio transversal en una muestra clínica de díadas paciente/ informador, 330 sujetos con sospecha de DC o demencia (DEM) y 71 controles. Se ha evaluado la consistencia interna ( de Cronbach) y la validez (correlaciones parciales con estadio GDS, Fototest e índice funcional [IF]). La UD se ha evaluado para no DC vs DC (GDS 3-4) por medio del área bajo la curva ROC (aROC) y se ha considerado mejor punto de corte aquel que hacía máximo el índice de Youden. Resultados: En la muestra, 105 no tenían DC, 99 tenían DC sin DEM y 203 DEM. La consistencia interna es alta ( 0,90, IC del 95%, 0,89-0,92), al igual que las correlaciones con GDS (r = 0,72, p < 0,001), Fototest (r = —0,61, p < 0,001) e IF (r = 0,59, p < 0,001). El aROC del AD8 es 0,90 (IC del 95%, 0,86-0,93), sin diferencia significativa con la del Fototest (aROC 0,93, IC del 95%, 0,89-0,96); el mejor punto de corte es 3/4 con sensibilidad de 0,93 (IC del 95%, 0,88-0,96), especificidad de 0,81 (IC del 95%, 0,72-0,88) y el 88,8% de las clasificaciones correctas. El uso conjunto de AD8 y Fototest mejora de forma significativa la UD de ambos (aROC 0,96, IC del 95%, 0,93-0,98, p < 0,05). Conclusiones: La versión espa˜nola del AD8 conserva las cualidades psicométricas y la UD de la versión original; su uso combinado con el Fototest mejora de forma significativa la UD de ambos (AU)

Introduction: The AD8 is a brief informant-based questionnaire that may also be selfadministered, and which aids in identifying cognitive impairment (CI). Our goal is to assess the diagnostic accuracy (DA) of a Spanish version of that questionnaire. Material and methods: Cross-sectional study of a clinical sample of patient/informant dyads including 330 subjects with suspected CI or dementia (DEM) and 71 controls. We evaluated internal consistency (Cronbach’s alpha) and validity (partial correlations with GDS stage, Fototest results and functional index measure [FIM]). We assessed DA for CI vs no CI (GDS stage 3-4) using the area under the ROC curve (AUC), and the cut-off with the highest Youden index was determined to be optimal. Results: In the sample, 105 subjects had no CI, 99 had CI without DEM and 203 had DEM. Internal consistency was high ( 0.90, 95% confidence interval: 0.89-0.92), as were correlations with the GDS score (r=0.72, P<.001), Fototest results (r=−0.61, P<.001) and FIM (r=0.59, P<.001). The AUC for AD8 was 0.90 (95% confidence interval: 0.86-0.93), which was not significantly different from that of the Fototest (AUC 0.93, 95% confidence interval: 0.89-0.96). The optimal cut-off point was 3/4 with a sensitivity of 0.93 (95% confidence interval: 0.88-0.96) and a specificity of 0.81 (95% confidence interval: 0.72-0.88); 88.8% of the classifications were correct. Combined use of AD8 and the Fototest significantly improved the DA of both (AUC 0.96, 95% confidence interval: 0.93-0.98, P<.05). Conclusions: The Spanish version of the AD8 questionnaire preserves the psychometric qualities and DA of the original. Using this test in combination with the Fototest significantly increases the DA of both tests (AU)

Assessing the diagnostic accuracy (DA) of the Spanish version of the informant-based AD8 questionnaire.

INTRODUCTION: The AD8 is a brief informant-based questionnaire that may also be self-administered, and which aids in identifying cognitive impairment (CI). Our goal is to assess the diagnostic accuracy (DA) of a Spanish version of that questionnaire. MATERIAL AND METHODS: Cross-sectional study of a clinical sample of patient/informant dyads including 330 subjects with suspected CI or dementia (DEM) and 71 controls. We evaluated internal consistency (Cronbach's alpha) and validity (partial correlations with GDS stage, Fototest results and functional index measure [FIM]). We assessed DA for CI vs no CI (GDS stage 3-4) using the area under the ROC curve (AUC), and the cut-off with the highest Youden index was determined to be optimal. RESULTS: In the sample, 105 subjects had no CI, 99 had CI without DEM and 203 had DEM. Internal consistency was high (α 0.90, 95% confidence interval: 0.89-0.92), as were correlations with the GDS score (r=0.72, P<.001), Fototest results (r=-0.61, P<.001) and FIM (r=0.59, P<.001). The AUC for AD8 was 0.90 (95% confidence interval: 0.86-0.93), which was not significantly different from that of the Fototest (AUC 0.93, 95% confidence interval: 0.89-0.96). The optimal cut-off point was 3/4 with a sensitivity of 0.93 (95% confidence interval: 0.88-0.96) and a specificity of 0.81 (95% confidence interval: 0.72-0.88); 88.8% of the classifications were correct. Combined use of AD8 and the Fototest significantly improved the DA of both (AUC 0.96, 95% confidence interval: 0.93-0.98, P<.05). CONCLUSIONS: The Spanish version of the AD8 questionnaire preserves the psychometric qualities and DA of the original. Using this test in combination with the Fototest significantly increases the DA of both tests.

[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.