Ecological assessment of mild cognitive impairment and Alzheimer disease using the Rivermead Behavioural Memory Test.

INTRODUCTION: The Rivermead Behavioural Memory Test (RBMT) is a short, ecologically-valid memory test battery that can provide data about a subject's memory function in daily life. We used RBMT to examine daily memory function in patients with mild cognitive impairment (MCI), Alzheimer disease (AD), and in healthy controls. We also evaluated differences between the memory profiles of subjects whose MCI remained stable after 1 year and those with conversion to AD. PATIENTS AND METHODS: Sample of 91 subjects older than 60 years: 30 controls, 27 MCI subjects and 34 AD patients. Subjects were assessed using MMSE and RBMT. RESULTS: The 40 men and 51 women in the sample had a mean age of 74.29±6.71 and 5.87±2.93 years of education. For the total profile and screening RBMT scores (P<.001) and total MMSE scores (P<.05), control subjects scored significantly higher than those with MCI, who in turn scored higher than AD patients. In all subtests, the control group (P<.001) and MCI group (P<.05) were distinguishable from the AD group. Prospective, retrospective, and orientation subtests found differences between the MCI and control groups (P<.05). MCI subjects who progressed to AD scored lower at baseline on the total RBMT and MMSE, and on name recall, belongings, story-immediate recall, route-delayed recall, orientation (P<.05), face recognition, story-delayed recall, and messages-delayed recall sections (P<.01). CONCLUSIONS: RBMT is an ecologically-valid episodic memory test that can be used to differentiate between controls, MCI subjects, and AD subjects. It can also be used to detect patients with MCI who will experience progression to AD.

Valoración de la capacidad de conducción de vehículos en pacientes con diagnóstico de deterioro cognitivo leve y demencia / Evaluation of the capacity to drive in patients diagnosed of mild cognitive impairment and dementia

Introducción. El deterioro cognitivo leve (DCL) y la demenciaconllevan cambios cognitivos que pueden influir enla conducción de vehículos.Objetivos. a) Estudiar la idoneidad de los tests utilizadosen la renovación de la licencia de conducir; b) estudiar la capacidadde conducción de los pacientes con DCL según lostests: ASDE Driver-Test y Useful Field of View (UFOV); c) estudiarla capacidad de conducción de los pacientes con demencialeve (DL) según los tests ASDE y UFOV; d) determinar quétests neuropsicológicos son adecuados para tomar la decisiónsobre la capacidad de conducción en DCL y DL; e) estudiar lasdiferencias en la evaluación de los diferentes tests neuropsicológicosentre los pacientes aptos para conducir y los que no encada uno de los subgrupos de DCL, y f) establecer la correlaciónentre los tests neuropsicológicos y los tests utilizados enla renovación de la licencia de conducir.Método. Se incluyeron 184 sujetos: 92 DCL, 55 DL y40 controles. La evaluación cognitiva se realizó medianteRepeatable Battery Assessment for NeuropsychologicalStatus (RBANS), Trail Making Test (TMT) y cubos de Kohs. Lacapacidad de conducción se evaluó mediante ASDE y testUFOV.Resultados. Se establecieron los puntos de corte paraASDE y UFOV. La sensibilidad y especificidad para el grupo deDL en el test ASDE fue del 86 y 95%, respectivamente, en elsubtest atención concentrada y resistencia a la monotonía; eltest UFOV mostró una sensibilidad del 88% y una especificidaddel 81%. En DCL ambos tests mostraron una sensibilidady especificidad inferior al 70 %. Según los resultados de lostests el 50% de los DCL pueden conducir y muestran diferentesperfiles en función del subtipo de DCL. Los tests neuropsicológicosque mostraron mejores correlaciones fueron: cubosde Kohs, memoria inmediata, memoria demorada y TMT-A (AU)

Introduction. Mild cognitive impairment (MCI) and dementia involve cognitive changes that may influence driving capacity. Objectives. a) To study if the tests used for renewing the driver’s licence are appropriate; b) to study the MCI patient’s driving capacity according to ASDE Driver-Test and Useful Field of View (UFOV) test; c) to study mild dementia (MD) patient’s driving capacity according to ASDE and UFOV tests; d) to determine which neuropsychological tests may be useful to make decisions on driving capacity in MCI and MD; e) to study the difference in the evaluation of each neuropsychological test bet-ween patients who are able to drive and those who are not, in each MCI subgroups, and f) we will establish the correlation between the neuropsychological tests and driving tests used for licence renewal. Method. A total of 184 people were included: 92 MCI, 55 MD and 40 healthy controls. Cognitive functioning was evaluated by Repeatable Battery Assessment for NeuropsychologicalStatus (RBANS), Trail Making Test (TMT) and Kohs’ Block Design. Driving capacity was assessed by ASDEand UFOV test. Results. We established the cut-off points for ASDE and UFOV tests. Sensitivity and specificity for the MD on the ASDE test was 86% and 95%, respectively for concentratedattention and monotony resistance subtest. The UFOV test sensitivity was 88%, specificity 81%. ForMCI, both tests showed a sensitivity and specificity lower than 70 %. According to the performance on the testonly a half of the MCI group could drive. They showed different driving profiles according to MCI subtype. Neuropsychologicaltests showing the best correlations withperformance on driving test were: Kohs’ Block Design,Immediate Memory, Delayed Memory and TMT-A (AU)

[Evaluation of the capacity to drive in patients diagnosed of mild cognitive impairment and dementia]. / Valoración de la capacidad de conducción de vehículos en pacientes con diagnóstico de deterioro cognitivo leve y demencia.

INTRODUCTION: Mild cognitive impairment (MCI) and dementia involve cognitive changes that may influence driving capacity. OBJECTIVES: a) To study if the tests used for renewing the driver's licence are appropriate; b) to study the MCI patient's driving capacity according to ASDE Driver-Test and Useful Field of View (UFOV) test; c) to study mild dementia (MD) patient's driving capacity according to ASDE and UFOV tests; d) to determine which neuropsychological tests may be useful to make decisions on driving capacity in MCI and MD; e) to study the difference in the evaluation of each neuropsychological test between patients who are able to drive and those who are not, in each MCI subgroups, and f) we will establish the correlation between the neuropsychological tests and driving tests used for licence renewal. METHOD: A total of 184 people were included: 92 MCI, 55 MD and 40 healthy controls. Cognitive functioning was evaluated by Repeatable Battery Assessment for Neuropsychological Status (RBANS), Trail Making Test (TMT) and Kohs' Block Design. Driving capacity was assessed by ASDE and UFOV test. RESULTS: We established the cut-off points for ASDE and UFOV tests. Sensitivity and specificity for the MD on the ASDE test was 86% and 95%, respectively for concentrated attention and monotony resistance subtest. The UFOV test sensitivity was 88%, specificity 81%. For MCI, both tests showed a sensitivity and specificity lower than 70 %. According to the performance on the test only a half of the MCI group could drive. They showed different driving profiles according to MCI subtype. Neuropsychological tests showing the best correlations with performance on driving test were: Kohs' Block Design, Immediate Memory, Delayed Memory and TMT-A. CONCLUSIONS: a) People with MD should not drive; b) both ASDE and UFOV tests can detect driving difficulties in people with dementia; c) according to the UFOV and ASDE, half of those diagnosed of MCI should not drive; d) there are significant differences in memory test (RBANS) between Amnesic MCI patients who are able to drive and those who are not (according to ASDE/UFOV tests); e) there are significant differences in TMT-A between multiple functions MCI patients who are able to drive and those who are not (according to ASDE/UFOV tests), and f) the neuropsychological tests that correlate with the driving test were: Kohs' Block Design, Immediate Memory, Delayed Memory and TMT-A.

Discriminación de la valoración de la capacidad de conducción de vehículos en personas con diagnóstico de deterioro cognitivo ligero y demencia en los exámenes de conducción normalizados / Assessment of dementia of car driving habilities in patients with mild cognitive impairment and dementia

El Deterioro Cognitivo Ligero (DCL) y la Demencia Leve pueden conllevar cambios cognitivos que afectan las capacidades instrumentales e influyen en la conducción segura. Algunas personas con alteraciones neuropsicológicas consideradas perjudiciales para una correcta conducción, habiendo superado recientemente las pruebas para la renovación del carné de conducir, continúan utilizando su vehículo con asiduidad. Sugerimos una batería neuropsicológica, de mínimos, que permita emitir un juicio clínico acerca de la seguridad de la conducción en pacientes con DCL y/o demencia. Se estudia el nivel de concordancia entre las pruebas especificas de conducción ASDE y UFOV. Muestra de población estudiada: 184 conductores: 92 DCL (edad: X=68,7; DS= 8,6), 55 Demencia Leve (edad: X=72,9; DS= 6,9) y 40 controles (edad: X=66,9; DS= 8,6), con similares características sociodemográficas. Se establecen puntos de corte para las pruebas ASDE y UFOV. Test ASDE (control vs demencia) en subtest RD muestra una sensibilidad: 86%, especificidad: 95%; TMRA2: sensibilidad: 93%, especificidad: 95%; R2: sensibilidad: 85%, esDepecificidad: 91%; R2: sensibilidad: 85%, especificidad: 91%. Test UFOV sensibilidad: 88% y especificidad: 81%. En el grupo de DCL muestra una baja sensibilidad y especificidad para ambas pruebas. Se presenta los índices de correlación entre pruebas neuropsicológicas mostrando diferencias entre sujetos de cada grupo según punto de corte de RD, TMR2, TMRA2 y RD2. Se aportan datos que sugieren la composición mínima de una batería neuropsicológica

MCI and Mild Dementia have cognitive changes that can affect instrumental capacities and influence driving safe. Some patients continue using their vehicle in spite of having been detected in them alterations in neuropsychological functions considered necessary for a correct driving and having recently overcome the tests for the renovation of the driving license. We suggest a neuropsychological battery that allows to emit a conclusion about the security of the driving in patient with MCI and/or dementia and to study the level of agreement among the driving tests ASDE and UFOV. We evaluated 184 drivers: 92 MCI (age: X=68,7; SD = 8,6) and 55 mild dementia (age: X=72,9; SD = 6,9) and 40 controls (age: X=66,9; SD = 8,6), matched up by age, educational level and gender. Cut-off settle down for the tests ASDE and UFOV. Test ASDE (control vs dementia) in subtest RD shows a sensibility: 86%, specificity: 95%; TMRA2: sensibility: 93%, specificity: 95%; R2: sensibility: 85%, specificity: 91%; R2: sensibility: 85%, specificity: 91%. Test UFOV sensibility: 88% and specificity: 81%. For the group of MCI it shows a low sensibility and specificity for both tests. The indexes of correlation are presented among neuropsychological tests showing differences among subjects of each group according to the point of cut of RD, TMR2, TMRA2 and RD2

[Memories and Alzheimer's disease]. / Las memorias y la enfermedad de Alzheimer.

INTRODUCTION: Alzheimer's disease (AD) is the most common cause of dementia in the elderly. Memory loss is generally the most pervasive cognitive symptom of AD but is not the only one and is not homogeneous in its loss. DEVELOPMENT: Memory complaint is one of the most frequent complaints in elderly people but not all complaints of memory inefficiencies in old age reflect dementing illnesses. Amnesia is the failure or lack of memory. Research in cognitive psychology and neuropsychology of memory has produced evidence than human memory is not a unitary aspect of human cognition but is organized in independent systems. Tulving (1995) and Van der Linden (1997) identified at least five major memory systems: primary memory or working memory, episodic memory, semantic memory, procedural system and perceptual priming. From a theoretical view of multiple memory systems, the purpose of the present conference is the review of multiple systems models of human memory and the memory processes, encoding, storage and retrieval in AD and memory assessment. Memory assessment is not limited by formal testing and requires ecological assessment by daily living tasks of AD patients. Appropriateness of multiple memory systems models is discussed.

[Constructive praxis to the copy: extended standards of the Barcelona test]. / Praxis constructiva a la copia: normas ampliadas del test Barcelona.

BACKGROUND: Drawings tasks have achieved a very central position in neurology by virtue of their sensitivity to many different kinds of brain lesions. Variables of age and education may significantly affect test performance and therefore should taken into account when developing test norms. OBJECTIVES: To increase the sample of the original version of the Barcelona test (BT) and analyze the results of the drawing task. PATIENTS AND METHODS: 322 normal subjects (47.1% women and 52.9% males), stratified in 7 groups according to age and education were included in the large sample. Copying subtest of the BT were used. Descriptive statistics and multiple lineal regression were applied to the data. RESULTS: Due to the relevance of age and education on coping drawing tasks (Kruskal-Wallis: p < 0.001 for age and p < 0.001 for education). Both variables (age and education) were analyzed using multiple lineal regression in order to establish possible effects of age and/or education for each group (F = 18.073; p < 0.001). Subjects aged more than 70 had the best adjust to the regression model (R2 = 0.4245; F = 18.07; p < 0.001; delta R2 = 13.56). Furthermore age has an important role as modulator to the results. CONCLUSIONS: Age and education influenced copying drawing performance for raw scores as well as when considering timed performance, in a different way for each studied group. While the correlation of education and performance on copy drawing tasks is a direct one, for age this relation is inverse.

[Abstract abilities: amplified norms for the Barcelona Test]. / Capacidades abstractas: normas ampliadas del Test Barcelona.

INTRODUCTION: By abstract abilities is understood the ability of comprehend relations identifying the essential components and taking out from them a common feature. Its evaluation constitutes a great challenge for neuropsychology. Several studies have showed the influence of age and formal education in the performance of tests assessing these abilities. AIM: To analyse the WAIS-style abstract abilities included in the abbreviated version of the Barcelona Test determining the influence of and formal education and obtaining more normative data for a Spanish population. METHOD: A sample of 264 subjects was randomly selected. The subtests of the Barcelona Test were administered in a single session to every subject. We selected the scores obtained in Arithmetic Problems (raw and timed), Similarities, Digit Symbol and Block Design (raw and timed). RESULTS: The analysis of the variance showed statistically significant results of the selected items according to age and formal education. The formal education, as the lineal regression showed, resulted significant for all the items, being the Arithmetic Problems the only subtests not influenced significantly by the formal education. CONCLUSION: The results obtained in this study are in general concordant to the ones of the reviewed bibliography.