[Monitoring cognitive characteristics in a population with hereditary cerebrovascular disease (CADASIL) in Colombia]. / Seguimiento de las características cognitivas en una población con enfermedad cerebrovascular hereditaria (CADASIL) en Colombia.

INTRODUCTION: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disease that affects small vessels and presents with vascular episodes, neuropsychiatric disorders, migraine and cognitive impairment. The cognitive disorder varies according to the time elapsed since onset. It is a condition with a subcortical origin related to executive dysfunction, slowing, attention-related disorders and memory disorders. AIM: To define the cognitive characteristics in two neuropsychological evaluations of carriers of Notch3 gene mutations as compared to non-carriers belonging to Colombian families with CADASIL. SUBJECTS AND METHODS: The study followed a longitudinal, retrospective design with 140 participants, including both carriers and non-carriers of the mutation. Cognitive performance was analysed by comparing the first and the last neuropsychological evaluation carried out on each subject at a four-year interval. RESULTS: There were statistically significant differences (p < 0.05) between the two groups in the last evaluation, but only in some tests. Carriers and non-carriers did not display any significant changes between the first and the last evaluation. CONCLUSIONS: No differences were found between both groups in the two evaluations. Cognitive impairment is not observed with the passage of time in carriers, probably owing to the fact that most of them were young, asymptomatic subjects. We believe that four years' follow-up is not enough time to observe a significant progression in the alterations affecting the cognitive functions in carriers of mutations in the Notch3 gene, which causes CADASIL. We also consider that more sensitive cognitive tools are needed to perform the neuropsychological evaluation.

[Validity and reliability of the CERAD-Col neuropsychological battery]. / Validez y fiabilidad de la batería neuropsicológica CERAD-Col.

INTRODUCTION: Alzheimer's disease (AD) is an important public health problem due to its disabling character and high individual, familial and social costs. The CERAD neuropsychological battery has been widely used for evaluation and diagnosis of the cognitive deficit associated with AD. This instrument has been adapted to the Colombian culture (CERAD-Col) for the Neurosciences Group. SUBJECTS AND METHODS: A study was carried out to establish the validity and reliability of the CERAD-Col in Colombian, Spanish-speaking individuals aged 50 years or more. It included 151 controls and 151 AD patients. Controls were selected from a convenience sample of 848 adults aged 50 years or more. The construct validity was determined in three ways: 1) factorial analysis; 2) correlation with the functional scales FAST and GDS (convergent-type validity) and, 3) comparison between the two groups. Internal consistency was determined by means of Cronbach's alpha coefficient. RESULTS: Three factors -memory, language and praxis- explained 88% of the total variance. Moderate but statistically significant correlations were found between neuropsychological tests and functional scales. Internal consistency and test-retest reproducibility were high. The AD group exhibited significantly lower scores (p < 0.05) than the control one. CONCLUSION: CERAD-Col is valid and reliable for the diagnosis of AD in Colombian Spanish-speaking population aged 50 years or more.

[A description of semantic memory performance in a sample of the Antioquian population]. / Descripción del desempeño en memoria semántica en una muestra de la población antioqueña.

INTRODUCTION: Available treatments for Alzheimer disease allow that early diagnosis become an important issue, because treatment only are useful during the earliest stage, especially during the mild cognitive impairment (MCI), when the most of the cognitive function is preserved. AIM: To observe the performance on a shortened version of a Semantic Cue Recall Memory Test (SCRMT) from a group of adult aged over 50 years old, living in Medellin city and with dementia of Alzheimer type (DAT). SUBJECTS AND METHODS: The sample was constituted by 30 patients with DAT, 30 with MCI, and 59 healthy controls, which were matched by socio economic strata and school achievement. The SCRMT was administered to the sample. For the analyses two groups of age (50-69 and over 70 years) were conformed. RESULTS: Comparisons statistically significant differences between the groups (p < 0.05). The scores were not significant affected by age. A combination of low scores with the presence of intrusions on the free, immediate cue, and delay cue recalls suggested the diagnosis of DAT, which allow recommending a complete neuropsychological assessment. Statistically significant differences were preserved when the groups were divided by age. The effect of the gender could not determine because the small size of the male sample. CONCLUSION: The shortened version of the SCMRT would appear be useful for the DAT diagnosis.

[Prevalence of mild cognitive impairment, amnestic-type, in a Colombian population]. / Prevalencia de deterioro cognitivo leve de tipo amnésico en una población colombiana.

INTRODUCTION: Mild cognitive impairment (MCI) is a clinical syndrome that presents with memory disorders, normal general cognition, and no compromise of activities of daily living or dementia. Its diagnosis has important clinical implications, since it behaves as a possible predictor of cognitive disorders that would suggest the onset of dementia. Amnestic-type MCI is considered to be a stage prior to Alzheimer-type dementia. The prevalence of MCI varies from 1-29% and the existence of this diagnosis implies a risk of presenting dementia at 12% per year. AIM: To establish the prevalence of amnestic-type MCI in a group of persons over the age of 50 years from the Valle de Aburra. PATIENTS AND METHODS: The sample was made up of 848 participants of both genders, over 50 years old, who lived in the metropolitan area of Medellin and had different socioeconomic and educational levels. Amnestic MCI was diagnosed according to the criteria proposed by the American Academy of Neurology. RESULTS: Prevalence of amnestic MCI was 9.7%, and was more predominant in males (p = 0.01) than in females. The prevalence was significantly lower in the group with more than 12 years of schooling (p < 0.05), and no significant differences in the prevalence were found in relation to age or economic status. CONCLUSION: The prevalence of amnestic MCI, 9.7%, found in our study is within the range reported by other researchers.

Prevalencia de deterioro cognitivo leve de tipo amnésico en una población colombiana / Prevalence of mild cognitive impairment, amnestic-type, ina a colombian population

Introducción. El deterioro cognitivo leve (DCL) es un síndrome clínico, se presenta con alteración de la memoria, cognición general normal, sin compromiso en las actividades de la vida diaria ni demencia. Su diagnóstico tiene implicaciones clínicas importantes, pues se comporta como un posible predictor de alteraciones cognitivas que sugerirían el inicio de una demencia. El DCL de tipo amnésico está asociado como estadio previo a la demencia de tipo Alzheimer. La prevalencia de DCL varía entre el 1-29%, y la existencia de este diagnóstico supone un riesgo de presentar demencia en un 12% por año. Objetivo. Establecer la prevalencia de DCL de tipo amnésico en un grupo de personas mayores de 50 años del Valle de Aburrá. Pacientes y métodos. La muestra fue conformada por 848 participantes de ambos géneros, mayores de 50 años de edad, residentes en el área metropolitana de Medellín, con diferentes niveles educativos y socioeconómicos. El diagnóstico de DCL amnésico se realizó de acuerdo con la propuesta de la Academia Americana de Neurología. Resultados. La prevalencia de DCL amnésico fue del 9,7%, con predominio en hombres (p = 0,01) frente a las mujeres. El comportamiento de la prevalencia fue significativamente menor en el grupo con más de 12 años de escolaridad (p < 0,05), y no hubo diferencias significativas de la prevalencia con la edad y el nivel económico. Conclusión. La prevalencia de DCL de tipo amnésico encontrada, del 9,7%, está dentro del rango informado en otras investigaciones (AU)

Introduction. Mild cognitive impairment (MCI) is a clinical syndrome that presents with memory disorders, normal general cognition, and no compromise of activities of daily living or dementia. Its diagnosis has important clinical implications, since it behaves as a possible predictor of cognitive disorders that would suggest the onset of dementia. Amnestic-type MCI is considered to be a stage prior to Alzheimer-type dementia. The prevalence of MCI varies from 1-29% and the existence of this diagnosis implies a risk of presenting dementia at 12% per year. Aim. To establish the prevalence of amnestic-type MCI in a group of persons over the age of 50 years from the Valle de Aburrá. Patients and methods. The sample was made up of 848 participants of both genders, over 50 years old, who lived in the metropolitan area of Medellín and had different socioeconomic and educational levels. Amnestic MCI was diagnosed according to the criteria proposed by the American Academy of Neurology. Results. Prevalence of amnestic MCI was 9.7%, and was more predominant in males (p = 0.01) than in females. The prevalence was significantly lower in the group with more than 12 years of schooling (p < 0.05), and no significant differences in the prevalence were found in relation to age or economic status. Conclusion. The prevalence of amnestic MCI, 9.7%, found in our study is within the range reported by other researcher (AU)

Seguimiento de las características cognitivas en una población con enfermedad cerebrovascular hereditaria (CADASIL) en Colombia / Monitoring cognitive characteristics in a population with hereditary cerebrovascular disease (CADASIL) in Colombia

La arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía (CADASIL)es una enfermedad hereditaria, afecta a pequeños vasos y se presenta con episodios vasculares, trastornos neuropsiquiátricos, migraña y deterioro cognitivo. La alteración cognitiva varía de acuerdo con el tiempo de evolución de la enfermedad; obedece a un cuadro de origen subcortical relacionado con disfunción ejecutiva, lentificación, afectación atencional y alteraciones de la memoria. Objetivo. Definir las características cognitivas en dos evaluaciones neuropsicológicas de portadores de mutaciones del gen Notch3 comparados con no portadores pertenecientes a familias colombianas con CADASIL. Sujetos y métodos. Diseño longitudinal, retrospectivo, con 140 participantes, portadores y no portadores de la mutación. Se analizó el rendimiento cognitivo comparando la primera y la última evaluación neuropsicológica efectuada a cada sujeto en un intervalode cuatro años. Resultados. Se presentaron diferencias estadísticamente significativas (p < 0,05) entre ambos grupos en la última evaluación, sólo en algunas pruebas. En portadores y no portadores no se encontraron cambios significativos entre la primera y la última evaluación. Conclusiones. No se encontraron diferencias entre ambos grupos en las dos evaluaciones. No se observa deterioro cognitivo con el paso del tiempo en los portadores, probablemente debido a que la mayoría eran sujetosasintomáticos y jóvenes. Se piensa que cuatro años de seguimiento no es tiempo suficiente para observar una progresión significativa en la alteración de las funciones cognitivas en portadores de mutaciones del gen Notch3 causante de CADASIL, o que la evaluación neuropsicológica requiere de herramientas cognitivas más sensibles

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)is a hereditary disease that affects small vessels and presents with vascular episodes, neuropsychiatric disorders, migraine and cognitive impairment. The cognitive disorder varies according to the time elapsed since onset. It is a condition with asubcortical origin related to executive dysfunction, slowing, attention-related disorders and memory disorders. Aim. To define the cognitive characteristics in two neuropsychological evaluations of carriers of Notch3 gene mutations as compared to noncarriersbelonging to Colombian families with CADASIL. Subjects and methods. The study followed a longitudinal,retrospective design with 140 participants, including both carriers and non-carriers of the mutation. Cognitive performance was analysed by comparing the first and the last neuropsychological evaluation carried out on each subject at a four-year interval. Results. There were statistically significant differences (p < 0.05) between the two groups in the last evaluation, butonly in some tests. Carriers and non-carriers did not display any significant changes between the first and the last evaluation.Conclusions. No differences were found between both groups in the two evaluations. Cognitive impairment is not observed with the passage of time in carriers, probably owing to the fact that most of them were young, asymptomatic subjects. We believe that four years’ follow-up is not enough time to observe a significant progression in the alterations affecting the cognitive functions in carriers of mutations in the Notch3 gene, which causes CADASIL. We also consider that more sensitive cognitive tools are needed to perform the neuropsychological evaluation

Validez y fiabilidad de la batería neuropsicológica CERAD-Col / Validaty and reliability of the cerad-col neuropsychological battery

La enfermedad de Alzheimer es un problema de importancia creciente en salud pública por su carácterincapacitante y su alto costo individual, familiar y social. La evaluación neuropsicológica contribuye significativamente a la identificación temprana de una demencia o de un deterioro cognitivo. La batería neuropsicológica del Consorcio para elEstablecimiento de un Registro de la Enfermedad de Alzheimer (CERAD) se usa ampliamente para la evaluación y diagnóstico del déficit cognitivo asociado con demencia tipo Alzheimer (DTA). Esta batería de pruebas neuropsicológicas se ha adaptado por el Grupo de Neurociencias de la Universidad de Antioquia (Colombia) con el nombre de CERAD-Col. Objetivo. Establecerla validez y fiabilidad del CERAD-Col en individuos con edades mayores o iguales a 50 años. Sujetos y métodos. Serealizó un estudio de validación, con 848 participantes seleccionados de la población general y 151 pacientes con DTA. La validez de constructo se determinó de tres formas: análisis factorial confirmatorio, correlación con las escalas funcionales FAST (Functional Assessment Staging) y EDG (escala de deterioro global), y comparación de ambos grupos. La consistenciainterna se estimó mediante el coeficiente alfa de Cronbach. Resultados. Se encontraron tres factores, memoria, lenguaje y praxias, que explicaron el 88% de la varianza total. Se hallaron correlaciones significativas entre las pruebas y las escalas FASTy EDG. La consistencia interna y la reproducibilidad test-retest fueron altas. El grupo con DTA mostró puntuaciones más bajas y significativas (p < 0,05) frente al grupo control. Conclusión. El CERAD-Col es válido y fiable para el diagnóstico de laDTA en la población colombiana hispanoparlante mayor de 50 años

Alzheimer’s disease (AD) is an important public health problem due to its disabling character and highindividual, familial and social costs. The CERAD neuropsychological battery has been widely used for evaluation and diagnosis of the cognitive deficit associated with AD. This instrument has been adapted to the Colombian culture (CERAD-Col) for theNeurosciences Group. Subjects and methods. A study was carried out to establish the validity and reliability of the CERAD-Col in Colombian, Spanish-speaking individuals aged 50 years or more. It included 151 controls and 151 AD patients. Controls were selected from a convenience sample of 848 adults aged 50 years or more. The construct validity was determined in three ways:1) factorial analysis; 2) correlation with the functional scales FAST and GDS (convergent-type validity) and, 3) comparison between the two groups. Internal consistency was determined by means of Cronbach’s alpha coefficient. Results. Three factors–memory, language and praxis– explained 88% of the total variance. Moderate but statistically significant correlations were found between neuropsychological tests and functional scales. Internal consistency and test-retest reproducibility were high. TheAD group exhibited significantly lower scores (p < 0.05) than the control one. Conclusion. CERAD-Col is valid and reliable for the diagnosis of AD in Colombian Spanish-speaking population aged 50 years or more

Descripción del desempeño en memoria semántica en una muestra de la población antioqueña / A description of semantic memory performance in a sample of the antioquian population

Introducción. La existencia de tratamientos para retardar la evolución de la demencia tipo Alzheimer (DTA) hace que la detección temprana sea importante, ya que estos tratamientos son efectivos si se inician cuando la mayoría de las funciones cognitivas aún están preservadas, o en la etapa de deterioro cognitivo leve (DCL). Objetivo. Observar la ejecución en la versión abreviada de la prueba de memoria semántica con clave (MSC), para el diagnóstico de demencias de un grupo de adultos mayores de 50 años del área metropolitana de Medellín. Sujetos y métodos. La muestra estuvo formada por 30 pacientes con DTA, 30 con DCL y 59 controles; se emparejaron por estrato socioeconómico y escolaridad. Se les aplicó la prueba abreviada de MSC, y se formaron dos subgrupos: uno de 50 a 69 años, y otro de 70 años en adelante. Resultados. La comparación de las puntuaciones en la prueba entre los tres grupos arrojó diferencias estadísticamente significativas (p < 0,05). El desempeño no se modificó con la edad. La combinación de bajas puntuaciones con la presencia de intrusiones en la evocación libre, diferida y con clave sugiere el diagnóstico de DTA, lo que justificaría una evaluación neuropsicológica detallada. Al estratificar la muestra por edad las diferencias continuaron siendo significativas. El efecto del sexo no se pudo observar por el bajo número de participantes de sexo masculino (AU)

Introduction. Available treatments for Alzheimer disease allow that early diagnosis become an important issue, because treatment only are useful during the earliest stage, especially during the mild cognitive impairment (MCI), when the most of the cognitive function is preserved. Aim. To observe the performance on a shortened version of a Semantic Cue Recall Memory Test (SCRMT) from a group of adult aged over 50 years old, living in Medellín city and with dementia of Alzheimer type (DAT). Subjects and methods. The sample was constituted by 30 patients with DAT, 30 with MCI, and 59 healthy controls, which were matched by socio economic strata and school achievement. The SCRMT was administered to the sample. For the analyses two groups of age (50-69 and over 70 years) were conformed. Results. Comparisons statistically significant differences between the groups (p < 0.05). The scores were not significant affected by age. A combination of low scores with the presence of intrusions on the free, immediate cue, and delay cue recalls suggested the diagnosis of DAT, which allow recommending a complete neuropsychological assessment. Statistically significant differences were preserved when the groups were divided by age. The effect of the gender could not determine because the small size of the male sample. Conclusion. The shortened version of the SCMRT would appear be useful for the DAT diagnosis (AU)