[Review of recommendations and new diagnosis criteria for mild cognitive impairment due to Alzheimer's disease]. / Revisión de los nuevos criterios y recomendaciones para el diagnóstico de Deterioro Cognitivo Leve debido a Enfermedad de Alzheimer.

The symptomatic predementia phase of Alzheimer's disease (AD), known as mild cognitive impairment (MCI) is a clinical and neuropsychological condition which defines the transitional state between normal aging and dementia, and is used as a clinical description of people at risk of developing AD. A review of the diagnostic criteria of MCI due to Alzheimer's disease was recently published by the Alzheimer's Association and the National Institute on Aging of the U.S. in order to ensure early diagnosis of the disease, useful for both clinical practice and clinical trials. The objectives of this paper are to review and analyze the revised diagnostic criteria for MCI due to Alzheimer's disease recently proposed, to compare with criteria for MCI available and to establish current strengths and limitations of the new proposal in clinical practice. The new diagnostic criteria for MCI due to AD have a radical importance since they are potentially applicable in the clinical or research protocols and in all clinical settings where such markers are available. They provide a useful, consistent and valuable tool to homogenize the subgroup of patients with MCI who already has AD in a predementia phase with inexorable progression to dementia by AD over the years.

Reliability of the Spanish version of the wheelchair skills test 4.2 for manual wheelchair users with spinal cord injury.

Study design: Cross-sectional.Objectives: The majority of people with a spinal cord injury (SCI) are dependent on wheelchair for their mobility. Approximately, 36% of wheelchair users reported that obstacles such as curbs, uneven terrain, flooring surfaces and thresholds were barriers to mobility. Several studies have shown that assessment and training of wheelchair skills leads to improvements in those skills. The purpose of our study was to translate the Wheelchair Skill Test (4.2) and its report form into Spanish and then determine the inter-rater reliability of the WST 4.2 for manual wheelchairs operated by their users.Setting: Rehabilitation Unit, FLENI Institute, Buenos Aires, Argentina.Methods: The translation was performed by a physical therapist with advanced English language skills and specialized in the treatment of SCI subjects. We administrated and video-recorded the WST 4.2 manual Spanish version in 11 SCI subjects. Two physical therapists received specific training for administering the test and scoring the record. The reliability of the total percentage WST score were statistically quantified by intraclass correlation coefficient (ICC).Results: ICC values for Interrater were 0.998 (p < .0001). 17 out of the 32 skills had a 100 percentage of agreement. Percentage of agreement in the three skills that presented less rating agreement was 73%, 81 % and 82 %, respectively.Conclusion: The results show that the Spanish version of WST 4.2 is a reliable assessment tool to evaluate the skills capacity of spinal cord manual wheelchair users.Implications for rehabilitationWheelchair users require a proficient management of various wheelchair skills to achieve maximum independence in daily life. Determining which wheelchair skills should be addressed during the rehabilitation process is of great importance for their correct training. The WST 4.2 is an appropriate assessment tool to determine the functional capacity of wheelchair users.Making available the WST 4.2 in the Spanish language and demonstrating its reliability in this language allows its use in the Spanish-speaking world. A reliable wheelchair skills test is needed in the Spanish language.

Adding Recognition Discriminability Index to the Delayed Recall Is Useful to Predict Conversion from Mild Cognitive Impairment to Alzheimer's Disease in the Alzheimer's Disease Neuroimaging Initiative.

Background: Ongoing research is focusing on the identification of those individuals with mild cognitive impairment (MCI) who are most likely to convert to Alzheimer's disease (AD). We investigated whether recognition memory tasks in combination with delayed recall measure of episodic memory and CSF biomarkers can predict MCI to AD conversion at 24-month follow-up. Methods: A total of 397 amnestic-MCI subjects from Alzheimer's disease Neuroimaging Initiative were included. Logistic regression modeling was done to assess the predictive value of all RAVLT measures, risk factors such as age, sex, education, APOE genotype, and CSF biomarkers for progression to AD. Estimating adjusted odds ratios was used to determine which variables would produce an optimal predictive model, and whether adding tests of interaction between the RAVLT Delayed Recall and recognition measures (traditional score and d-prime) would improve prediction of the conversion from a-MCI to AD. Results: 112 (28.2%) subjects developed dementia and 285 (71.8%) subjects did not. Of the all included variables, CSF Aß1-42 levels, RAVLT Delayed Recall, and the combination of RAVLT Delayed Recall and d-prime were predictive of progression to AD (χ2 = 38.23, df = 14, p < 0.001). Conclusions: The combination of RAVLT Delayed Recall and d-prime measures may be predictor of conversion from MCI to AD in the ADNI cohort, especially in combination with amyloid biomarkers. A predictive model to help identify individuals at-risk for dementia should include not only traditional episodic memory measures (delayed recall or recognition), but also additional variables (d-prime) that allow the homogenization of the assessment procedures in the diagnosis of MCI.