Neurological Disorders in Central Spain, Second Survey: Feasibility Pilot Observational Study.

BACKGROUND: The Neurological Disorders in Central Spain, second survey (NEDICES-2) is a population-based, closed-cohort study that will include over 8000 subjects aged ≥55 years. It will also include a biobank. OBJECTIVE: The objective of this study was to evaluate all major aspects of the NEDICES-2 (methods, database, screening instruments, and questionnaires, as well as interexpert rating of the neurological diagnoses) in each one of the planned areas (all of them in central Spain) and to test the possibility of obtaining biological samples from each participant. METHODS: A selection of patients and participants of the planned NEDICES-2 underwent face-to-face interviews including a comprehensive questionnaire on demographics, current medications, medical conditions, and lifestyle habits. Biological samples (blood, saliva, urine, and hair) were also obtained. Furthermore, every participant was examined by a neurologist. RESULTS: In this pilot study, 567 study participants were enrolled (196 from hospitals and 371 from primary care physician lists). Of these 567, 310 completed all study procedures (questionnaires and the neurological evaluation). The study was time-consuming for several primary care physicians. Hence, a few primary care physicians from some areas refused to participate, which led to a reconfiguration of study areas. In addition, the central biobank needed to be supplemented by the biobanks of local Spanish National Health System hospitals. CONCLUSIONS: Population-based epidemiological surveys, such as the NEDICES-2, require a pilot study to evaluate the feasibility of all aspects of a future field study (population selection, methods and instruments to be used, neurological diagnosis agreement, and data collection).

Assessing inhibitory control in early-stage Alzheimer's and Parkinson's disease using the Hayling Sentence Completion Test.

The ability to inhibit irrelevant information is essential for coping with the demands of everyday life. Inhibitory deficits are present in all stages of dementia and commonly observed in people with Parkinson's disease (PwPD). Inhibition is frequently tested with the Stroop test, but this may lack ecological validity. This study investigates inhibitory control in people with Alzheimer's disease dementia (PwD) and PwPD using the Hayling Sentence Completion Test (HSCT), which aspires to be a more ecologically valid task. A total of 117 people completed the HSCT, a test where participants have to complete a sentence with an unrelated word. The sample comprised 30 PwD, 33 PwPD, and 54 healthy older controls. We compared response times and the number and type of errors across the three groups. Completion time in Part B (Inhibition) did not distinguish between PwD, PwPD, and controls when controlling for the initiation speed, but a higher proportion of Category A errors (producing a word that fits the sentence when instructed otherwise) was a unique characteristic of inferior performance in PwD and PwPD. While not part of the standard test scoring protocol, controlling for the initiation speed and distinguishing between speed and accuracy in test performance appear to be essential for accurate evaluation of the inhibitory control in HSCT in older people. The findings suggest that the HSCT may be sensitive to verbal suppression deficits and may provide insight into inhibitory control in PwD and PwPD.

Spanish version of the Mattis Dementia Rating Scale-2 for early detection of Alzheimer's disease and mild cognitive impairment.

OBJECTIVE: We aimed to analyse the clinical utility of the Mattis Dementia Rating Scale (MDRS-2) for early detection of Alzheimer's disease (AD) and amnestic mild cognitive impairment (MCI) in a sample of Spanish older adults. METHODS: A total of 125 participants (age = 75.12 ± 6.83, years of education =7.08 ± 3.57) were classified in three diagnostic groups: 45 patients with mild AD, 37 with amnestic MCI-single and multiple domain and 43 cognitively healthy controls (HCs). Reliability, criterion validity and diagnostic accuracy of the MDRS-2 (total and subscales) were analysed. The MDRS-2 scores, adjusted by socio-demographic characteristics, were calculated through hierarchical multiple regression analysis. RESULTS: The global scale had adequate reliability (α = 0.736) and good criterion validity (r = 0.760, p < .001) with the Mini-Mental State Examination. The optimal cut-off point between AD patients and HCs was 124 (sensitivity [Se] = 97% and specificity [Sp] = 95%), whereas 131 (Se = 89%, Sp = 81%) was the optimal cut-off point between MCI and HCs. An optimal cut-off point of 123 had good Se (0.97), but poor Sp (0.56) to differentiate AD and MCI groups. The Memory and Initiation/Perseveration subscales had the highest discriminative capacity between the groups. CONCLUSIONS: The MDRS-2 is a reliable and valid instrument for the assessment of cognitive impairment in Spanish older adults. In particular, optimal capacity emerged for the detection of early AD and MCI. Copyright © 2017 John Wiley & Sons, Ltd.

Normative Data of the Story and Six-Object Memory Recall Tests in Older Spanish Adults: NEDICES Population-Based Cohort.

OBJECTIVE: We provide normative data for the story and six-object recall tasks, stratified by age and education in a large population-based cohort of older Spanish adults. METHOD: The sample consisted of 2,581 participants without dementia (age range: 67-98 years) from different socioeconomic areas of central Spain. Normative data are presented in percentile ranks and divided into four overlapping age tables with different midpoints. RESULTS: Spearman correlations and shared variances were calculated to evaluate the effects of sociodemographic variables on both tasks. Our findings showed that age and education influence the scores in the story and six-object recall tasks, whereas sex had null effect on story recall and an almost negligible on object recall, respectively. CONCLUSION: The norms presented herein are important for the correct interpretation of scores in the story and six-object recall tasks when assessing older adults in Spain.

Semantic Verbal Fluency: Normative Data in Older Spanish Adults From NEDICES Population-Based Cohort.

OBJECTIVE: We aimed to provide the normative data stratified by age, sex and educational attainment for two semantic categories (animal and fruits) in older Spanish adults. METHOD: A representative sample of 2,744 non-demented older individuals with different socioeconomic background was selected from the Neurological Disorders in Central Spain (NEDICES), a population-based study. Normative data are presented in percentile ranks and divided into four age-tables with different midpoints, using the overlapping interval procedure. RESULTS: Correlation analyses showed that age, education and sex influence significantly the scores in both semantic tasks. Normative data presented here covered two urban (Margaritas & Lista) and one rural areas (Arévalo). CONCLUSION: These norms may provide useful data for screening cognitive impairment more accurately in Spanish older adults.

Prognostic Significance of Mild Cognitive Impairment Subtypes for Dementia and Mortality: Data from the NEDICES Cohort.

BACKGROUND: The predictive value of diverse subtypes of mild cognitive impairment (MCI) for dementia and death is highly variable. OBJECTIVE: To compare the predictive value of several MCI subtypes in progression to dementia and/or mortality in the NEDICES (Neurological Disorders in Central Spain) elderly cohort. METHODS: Retrospect algorithmic MCI subgroups were established in a non-dementia baseline NEDICES cohort using Spanish adaptations of the original Mini-Mental State Examination (MMSE-37) and Pfeffer's Functional Activities Questionnaire (Pfeffer-11). The presence of MCI was defined according two cognitive criteria: using two cut-offs points on the total MMSE-37 score. Five cognitive domains were used to establish the MCI subtypes. Functional capacity (Pfeffer-11) was preserved or minimally impaired in all MCI participants. The incident dementia diagnoses were established by specialists and the mortality data obtained from Spanish official registries. RESULTS: 3,411 participants without dementia were assessed in 1994-5. The baseline prevalence of MCI varied according to the MCI definition (4.3%-31.8%). The follow-up was a mean of 3.2 years (1997-8). The dementia incidence varied between 14.9 and 71.8 per 1,000/person-years. The dementia conversion rate was increased in almost all MCI subgroups (p >  0.01), and mortality rate was raised only in four MCI subtypes. The amnestic-multi-domain MCI (aMd-MCI) had the best dementia predictive accuracy (highest positive likelihood ratio and highest clinical utility when negative). CONCLUSIONS: Those with aMd-MCI were at greatest risk of progression to dementia, as in other surveys and might be explored with increased attention in MCI research and in dementia preventive trials.