Normative and reliability study of Fototest.

INTRODUCTION: The Fototest is a brief cognitive test suitable for illiterate persons, and valid and accurate for detecting cognitive impairment or dementia. Our aim was to conclude the development of this instrument carrying out a normative and reliability study. METHOD: The normative study was performed on a convenience sample of 223 healthy volunteers aged between 20 and 85 years. The test-retest reliability was assessed through a repeated-measures cross-sectional design on a sample of 50 subjects with no cognitive impairment; the inter-rater reliability was determined by the blind assessment of 10 test applications performed by 30 independent observers; in both instances, reliability was expressed as intra-class correlation coefficient. Internal consistency was analysed by Cronbach's alpha coefficient. RESULTS: The results on the Fototest are normally distributed and are not influenced by gender or educational level but they do vary with age. The test-retest reliability of the Fototest was 0.89 (95% CI: 0.81-0.93); the inter-rater reliability, 0.98 (95% CI: 0.96-0.99); and the internal consistency, 0.94. CONCLUSIONS: The Fototest is free from educational influence and shows appropriate test-retest and inter-rater reliabilities, as well as a high internal consistency. Therefore, it is a suitable psychometric instrument to be used in the follow-up of patients with cognitive impairment or dementia, especially in contexts where evaluators are not the same on different occasions, or with patients of low educational level.

[Impact of warning against procrastination of thrombolysis in ischemic stroke]. / Impacto de las advertencias contra la procrastinación sobre las demoras en la trombólisis del ictus.

INTRODUCTION: Fibrinolysis in stroke should be carried out as soon as possible, but delays occur for various reasons. In the first 17 ischemic infarcts treated in our center we confirmed a tendency to exhaust the therapeutic window. We look now at whether warnings against this tendency, without other logistical or organizational modifications, have had an impact on delays. PATIENTS AND METHODS: Neurologists were encouraged to avoid procrastination. When we reached 51 treated patients, we compared features and delay times between the first 17 (February, 2002 to June, 2004) and the 17 most recent cases (October, 2005 to April, 2006). Non-parametric tests were used (significant if p < 0.05). RESULTS: Both groups were similar clinically and demographically. The onset-arrival time lengthened (46 min vs. 75 min; p = 0.01) and scattered. The CT-treatment time halved (57 min vs. 30 min; p = 0.001), with consequent shortening of the 'door-to-needle' period (121 min vs. 90 min; p = 0.002). The arrival-CT time had remained constant (50 min vs. 53 min; p = 0.9), thus the total delay from onset did not change significantly (165 min vs. 170 min; p = 0.7), and the inverse linear correlation between the onset-CT time and the CT-treatment time weakened. CONCLUSIONS: Warnings against procrastination appear to be important in terms of shortening the delays. The time used for clinical-radiologic evaluation (arrival through CT)--about which there had been no action taken--had not been modified, but the time employed in the decision to treat (CT-treatment) and the 'door-to-needle' time had decreased appreciably. This effective compensatory reduction permitted treatment of late-arriving patients, such that although the overall time from onset to treatment apparently was not modified, the actual treatment rate increased.

[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.