Traducción y adaptación española de la batería neuropsicológica Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) forma A en una muestra piloto / Spanish translation and adaptation of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Form A in a pilot sample

Introducción: La RBANS es una batería neuropsicológica breve que se ha mostrado sensible para la detección de trastorno cognitivo en patología degenerativa y no degenerativa. Ha sido traducida y adaptada a diversas lenguas y es ampliamente utilizada en otros países, pero no se ha publicado ninguna versión española. El objetivo es realizar una traducción válida al español de la RBANS y obtener una versión adaptada a la población española. Pacientes y métodos: Participaron 73 sujetos, 25 hombres, con una edad media de 54 años y escolaridad de 9,72, y 48 mujeres, con edad media de 53 y escolaridad 10,29. Se realizó una traducción mediante el método traducción-retrotraducción (con matices) y posteriormente se realizó un estudio descriptivo piloto en una muestra de población normal. Resultados: En la traducción y la adaptación de la batería neuropsicológica RBANS forma A (1998) se obtuvo un coeficiente de fiabilidad global con una alfa de Cronbach de 0,73. Se obtuvieron correlaciones positivas, estadísticamente significativas entre los índices. Conclusiones: La versión traducida y adaptada al castellano se comporta de forma similar a la versión original (AU)

Introduction: RBANS is a short neuropsychological battery which has shown to be sensitive in detecting cognitive impairment in degenerative and non-degenerative diseases. It has been translated and adapted to different languages and is widely used in other countries, but no Spanish version has been published. The objective was to make a valid translation of the RBANS to Spanish, and obtain a version adapted to the Spanish population. Patients and methods: The study included 73 subjects: 25 males with a mean age of 54 years and 9.72 years of education, and 48 females with a mean age of 53 years and 10.29 years of education. The battery was translated using the translation-back-translation method (with slight differences), followed by a descriptive pilot study in a sample of the normal population. Results: An overall reliability coefficient with a Cronbach alpha of 0.73 was obtained in the translation and adaptation of the RBANS, Form A (1998). Statistically significant positive correlations between the indices were obtained. Conclusions: The version translated and adapted to Spanish performs similarly to the original version (AU)

Spanish translation and adaptation of the repeatable battery for the assessment of neuropsychological status (RBANS) Form A in a pilot sample.

INTRODUCTION: RBANS is a short neuropsychological battery which has shown to be sensitive in detecting cognitive impairment in degenerative and non-degenerative diseases. It has been translated and adapted to different languages and is widely used in other countries, but no Spanish version has been published. The objective was to make a valid translation of the RBANS to Spanish, and obtain a version adapted to the Spanish population. PATIENTS AND METHODS: The study included 73 subjects: 25 males with a mean age of 54 years and 9.72 years of education, and 48 females with a mean age of 53 years and 10.29 years of education. The battery was translated using the translation-back-translation method (with slight differences), followed by a descriptive pilot study in a sample of the normal population. RESULTS: An overall reliability coefficient with a Cronbach alpha of 0.73 was obtained in the translation and adaptation of the RBANS, Form A (1998). Statistically significant positive correlations between the indices were obtained. CONCLUSIONS: The version translated and adapted to Spanish performs similarly to the original version.

[Analysis of the demand for neurological health care generated by primary care in a geographical area within the districts of Girona]. / Análisis de la demanda asistencial neurológica generada por la atención primaria en una área geográfica de las comarcas de Girona.

AIM: To perform a descriptive analysis of the outpatient activity in a neurological department in terms of the frequency and type of neurological diseases that were attended. PATIENTS AND METHODS: A retrospective and cross-sectional study was conducted involving patients referred to the neurology outpatients department. The cases that visited for the first time during the years 2006 and 2007 were recorded consecutively. Medical information was evaluated based on computerised hospital registers and the following data were collected: health referral area, date of visit, age, sex and diagnosis according to the International Classification of Diseases, 9th edition, clinical modification (CIE-9-MC), reconverted into the International Classification of Diseases, 10th edition (CIE-10). RESULTS: The mean age was 60.6 +/- 20.9 years (range: 4-95 years) and 61.4% were females. The rate of frequency of visits was 4.3 requests/1000 inhabitants for the year 2006 and 3.9 for the year 2007; an increase was observed with age for the neurodegenerative diseases. As far as the CIE-10 is concerned, the diseases were classified as episodic and paroxysmal (25%), degenerative and demyelinating (18.6%), organic mental disorders (14.7%), extrapyramidal syndromes (10.5%), diseases affecting cerebral circulation (3.5%), stress-related disorders and somatomorphs (3.5%) and diseases of the inner ear (3.3%). The remaining pathologies did not reach 3% of the total. Diseases of the central nervous system were observed in 61% of the patients and psychiatric disorders were found in 20.3%. The most common diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies. CONCLUSIONS: The frequency of visits increases with age and the order, in terms of frequency, was: episodic and paroxysmal, degenerative and demyelinating, psychotic and behavioural disorders, and extrapyramidal syndromes.

Análisis de la demanda asistencial neurológica generada por la atención primaria en una área geográfica de las comarcas de Girona / Analysis of the demand for neurological health care generated by primary care in a geographical area within the districts of Girona

Objetivo. Análisis descriptivo de la actividad ambulatoria en un servicio de neurología en relación con la frecuenciay tipo de enfermedades neurológicas atendidas. Pacientes y métodos. Estudio retrospectivo y trasversal de los pacientesremitidos a la consulta ambulatoria de neurología. Se registraron consecutivamente los casos visitados por primera vez durantelos años 2006 y 2007. Se evaluó la documentación médica a partir de los registros hospitalarios informatizados, recogiéndose:zona de salud de referencia, fecha de visita, edad, sexo y diagnóstico según la Clasificación Internacional de Enfermedades,9.ª edición, modificación clínica (CIE-9-MC), reconvertida a la Clasificación Internacional de Enfermedades, 10.ªedición (CIE-10). Resultados. La media de edad fue de 60,6 ± 20,9 años (rango: 4-95 años) y el 61,4% fueron mujeres. El índicede frecuentación fue de 4,3 solicitudes/1.000 habitantes para el año 2006 y de 3,9 para el año 2007, y se observó unincremento con la edad para las enfermedades neurodegenerativas. Respecto a la CIE-10, las enfermedades se clasificaroncomo episódicas y paroxísticas (25%), degenerativas y desmielinizantes (18,6%), trastornos mentales orgánicos (14,7%), síndromesextrapiramidales (10,5%), enfermedades de la circulación cerebral (3,5%), trastornos relacionados con el estrés y somatomorfos(3,5%) y enfermedades del oído interno (3,3%). Las demás patologías no alcanzaron el 3%. El 61% de los pacientespresentó enfermedades del sistema nervioso central y el 20,3%, trastornos psiquiátricos. Las enfermedades más frecuentesfueron los trastornos cognitivos (31,5%), las cefaleas (18,6%) y los trastornos del movimiento (11,7%), seguidas delas enfermedades psiquiátricas, epilepsias, enfermedades cerebrovasculares y neuropatías(AU)

Aim. To perform a descriptive analysis of the outpatient activity in a neurological department in terms of thefrequency and type of neurological diseases that were attended. Patients and methods. A retrospective and cross-sectional study was conducted involving patients referred to the neurology outpatients department. The cases that visited for the first time during the years 2006 and 2007 were recorded consecutively. Medical information was evaluated based on computerisedhospital registers and the following data were collected: health referral area, date of visit, age, sex and diagnosis according to the International Classification of Diseases, 9th edition, clinical modification (CIE-9-MC), reconverted into the InternationalClassification of Diseases, 10th edition (CIE-10). Results. The mean age was 60.6 ± 20.9 years (range: 4-95 years) and 61.4% were females. The rate of frequency of visits was 4.3 requests/1000 inhabitants for the year 2006 and 3.9 for the year2007; an increase was observed with age for the neurodegenerative diseases. As far as the CIE-10 is concerned, the diseases were classified as episodic and paroxysmal (25%), degenerative and demyelinating (18.6%), organic mental disorders (14.7%), extrapyramidal syndromes (10.5%), diseases affecting cerebral circulation (3.5%), stress-related disorders and somatomorphs (3.5%) and diseases of the inner ear (3.3%). The remaining pathologies did not reach 3% of the total. Diseases of the central nervous system were observed in 61% of the patients and psychiatric disorders were found in 20.3%. The mostcommon diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies(AU)

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.

[Guide to the comprehensive treatment of spasticity]. / Guia del tratamiento integral de la espasticidad.

AIMS AND DEVELOPMENT: Spasticity is an important medical problem with a high rate of incidence both in childhood, mainly as a result of cerebral palsy, and in adults, which is frequently brought about by traumatic brain injuries, strokes and spinal cord injuries. Spasticity is part of upper motoneuron syndrome, which gives rise to important problems, such as limited joint movement, abnormal postures that can produce pain, impaired functional capacity, aesthetic or hygiene disorders, among others. It progresses naturally towards chronicity, accompanied by static phenomena due to alterations affecting the properties of soft tissues (elasticity, plasticity and viscosity). Numerous therapeutic options are available for the treatment of spasticity, including medication, physiotherapy, orthopaedic aid, surgery, and so forth. Moreover, treatment should be individualised and realistic, with goals that have been agreed between the patient or caregiver and the medical team. The aim of the following guide is to further our knowledge of this condition, its causes, epidemiology and progression, as well as to outline an approach that is both rational and global from the point of view of pharmacological, rehabilitation and surgical treatment. CONCLUSIONS: Spasticity is a complex problem that requires specialists (neurologist, rehabilitation doctor, occupational therapist, orthopaedic surgeon, general practitioner, etc.) to work as a team in order to achieve the goals set out when treatment is begun. Early treatment is important to avoid or reduce, as far as possible, the severe complications stemming from this condition.

[Early-onset Parkinsonism. A report on a Spanish series]. / Parkinson de inicio precoz. A proposito de una serie espanola.

INTRODUCTION: Early-onset Parkinsonism is a condition that has received little attention from researchers due to its low incidence and prevalence. We conducted a retrospective, cross-sectional, multi-centre study in order to obtain a representative sample of the Spanish population. PATIENTS AND METHODS: The study involved 92 Spanish patients who had been diagnosed with idiopathic Parkinson's disease that began before the age of 40 years and these patients were divided into two groups: group 1, which consisted of 86 patients, with an age at onset of between 21 and 40 years (early-onset Parkinsonism), and group 2, with an age at onset of below 21 years, which included a total of 6 patients (juvenile Parkinsonism). Our analysis involved demographic data, patient's personal and family history, age and symptoms of onset of the disease, complementary studies, drug therapy and pharmacological complications. RESULTS: In group 1 we found a high incidence of early-onset Parkinsonism in the family. In our series there was a clear predominance of patients from urban settings. The predominant form of onset was akinesia, followed by tremor at rest, rigidity and postural tremor. Since they began treatment with levodopa, some patients presented fluctuations and dyskinesias which progressively increased over the years. CONCLUSIONS: Our series of patients is not wholly similar to those reported in the literature; it is comparable, however, to those found in western countries and can be considered to be valid due to the number of cases analysed and owing to the fact that patients were selected from different areas around Spain. This provides an overall picture of this subtype of Parkinson's disease for the country as a whole.

Parkinson de inicio precoz. A propósito de una serie española / Early-onset parkinsonism a report on a Spanish series

El Parkinson de inicio precoz es una entidad poco estudiada a causa de la baja incidencia y prevalencia.Hemos realizado un estudio retrospectivo transversal multicéntrico para tener una muestra representativa de la población española. Pacientes y métodos. Se incluyeron en el estudio 92 pacientes españoles diagnosticados de enfermedad de Parkinsonidiopática de inicio antes de los 40 años, que se dividieron en dos grupos: grupo 1, con 86 pacientes, con edad de inicio entre 21 y 40 años (Parkinson de inicio precoz), y grupo 2, con edad de inicio inferior a los 21 años, con un total de 6 pacientes (Parkinson juvenil). Analizamos: datos demográficos, antecedentes personales y familiares, edad y síntomas de comienzode la enfermedad, estudios complementarios, farmacoterapia y complicaciones farmacológicas. Resultados. En el grupo 1 encontramos una gran incidencia familiar de Parkinson de inicio precoz. En nuestra serie hubo un claro predominiode pacientes del medio urbano. La forma predominante de inicio fue la acinesia, seguida del temblor de reposo, rigidez y temblor de actitud. Algunos pacientes presentaron, desde el inicio del tratamiento con levodopa, fluctuaciones y discinesias queaumentaron progresivamente a lo largo de los años. Conclusiones. Nuestra serie de pacientes no es totalmente similar con lasdescritas en la literatura; sí es parecida a las encontradas en los países occidentales y tiene validez por el número de casosanalizados y por seleccionar pacientes de varios sitios del territorio español, dando una imagen general sobre este subtipo de enfermedad de Parkinson nacionalmente

Early-onset Parkinsonism is a condition that has received little attention from researchers due to itslow incidence and prevalence. We conducted a retrospective, cross-sectional, multi-centre study in order to obtain a representative sample of the Spanish population. Patients and methods. The study involved 92 Spanish patients who had been diagnosed with idiopathic Parkinson's disease that began before the age of 40 years and these patients were divided into twogroups: group 1, which consisted of 86 patients, with an age at onset of between 21 and 40 years (early-onset Parkinsonism), and group 2, with an age at onset of below 21 years, which included a total of 6 patients (juvenile Parkinsonism). Our analysisinvolved demographic data, patient’s personal and family history, age and symptoms of onset of the disease, complementary studies, drug therapy and pharmacological complications. Results. In group 1 we found a high incidence of early-onset Parkinsonism in the family. In our series there was a clear predominance of patients from urban settings. The predominant form of onset was akinesia, followed by tremor at rest, rigidity and postural tremor. Since they began treatment with levodopa, some patients presented fluctuations and dyskinesias which progressively increased over the years. Conclusions. Our series of patients is not wholly similar to those reported in the literature; it is comparable, however, to those found in western countries and can be considered to be valid due to the number of cases analysed and owing to the fact that patients were selected from different areas around Spain. This provides an overall picture of this subtype of Parkinson's disease for the country as a whole

Guía del tratamiento integral de la espasticidad / Guide to the comprehensive treatment of spasticity

Objetivos y desarrollo. La espasticidad constituye un problema médico de incidencia y trascendencia elevada tanto en la infancia, como consecuencia principalmente de la parálisis cerebral, como en adultos, ocasionada frecuentemente por traumatismos craneoencefálicos, ictus y lesión medular. La espasticidad forma parte del síndrome de motoneurona superior que ocasiona problemas importantes, como son: limitación articular, posturas anómalas que pueden generar dolor, alteraciónde la capacidad funcional, alteraciones estéticas o de higiene, entre otras. Su evolución natural es hacia la cronicidad, acompañada de fenómenos estáticos por alteraciones de las propiedades de los tejidos blandos (elasticidad, plasticidad y viscosidad).Las opciones terapéuticas de la espasticidad son múltiples: fármacos, fisioterapia, ayudas ortopédicas, cirugía, etc.Además, el tratamiento debe ser individualizado y realista, con unos objetivos consensuados entre el paciente o cuidador y el equipo médico. El objetivo de la siguiente guía es profundizar en el conocimiento de esta patología, sus causas, epidemiologíay evolución, así como aportar una forma racional y global de abordaje desde el punto de vista del tratamiento farmacológico, rehabilitador y quirúrgico. Conclusión. La espasticidad es un problema complejo que requiere un trabajo en equipo(neurólogo, rehabilitador, terapeuta ocupacional, cirujano ortopeda, médico de familia, etc.) para conseguir los objetivos que se fijan al principio de su tratamiento. Es importante el tratamiento precoz para evitar o reducir, en la medida de lo posible, las graves complicaciones que conlleva

Aims and development. Spasticity is an important medical problem with a high rate of incidence both in childhood,mainly as a result of cerebral palsy, and in adults, which is frequently brought about by traumatic brain injuries, strokes and spinal cord injuries. Spasticity is part of upper motoneuron syndrome, which gives rise to important problems, such as limitedjoint movement, abnormal postures that can produce pain, impaired functional capacity, aesthetic or hygiene disorders, among others. It progresses naturally towards chronicity, accompanied by static phenomena due to alterations affecting the properties of soft tissues (elasticity, plasticity and viscosity). Numerous therapeutic options are available for the treatment ofspasticity, including medication, physiotherapy, orthopaedic aid, surgery, and so forth. Moreover, treatment should be individualised and realistic, with goals that have been agreed between the patient or caregiver and the medical team. The aimof the following guide is to further our knowledge of this condition, its causes, epidemiology and progression, as well as to outline an approach that is both rational and global from the point of view of pharmacological, rehabilitation and surgicaltreatment. Conclusions. Spasticity is a complex problem that requires specialists (neurologist, rehabilitation doctor, occupational therapist, orthopaedic surgeon, general practitioner, etc.) to work as a team in order to achieve the goals set outwhen treatment is begun. Early treatment is important to avoid or reduce, as far as possible, the severe complications stemming from this condition

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

[Guidelines for the treatment of child spasticity using botulinum toxin]. / Guía terapéutica de la espasticidad infantil con toxina botulínica.

AIMS: The introduction of botulinum toxin has been a significant step forward in the treatment of spasticity in children and is now considered to be the preferred treatment in focal spasticity. With the aim of optimising this therapeutic resource, a group of Spanish neurologists and specialists in rehabilitation have drawn up these therapeutic guidelines based on the currently available evidence on its use and indications, and on their own experience. DEVELOPMENT: Spasticity in childhood is mainly caused by infantile cerebral palsy. Its natural history is not favourable due to the negative effect of growth and it should be treated before permanent deformities in bones and joints appear. Treatment with botulinum toxin diminishes hyperactivity and muscle tone, and allows the muscle to grow longitudinally, which prevents permanent contractions. The advantages of botulinum toxin are obvious (ease of use and dosing, long-lasting effects, reversibility in case of adverse responses, and so forth) and outnumber by far the few drawbacks it offers. Before it can be used patients, treatment goals and the muscle areas to be treated must all be selected correctly and, at the same time, a tailored rehabilitation scheme must also be developed. The growing body of experience suggests that its early administration is effective in preventing or reducing the severe complications of spasticity. CONCLUSIONS: Botulinum toxin type A is very effective in the treatment of spasticity. These guidelines offer the well-documented experience gained from its use and our knowledge about its indications, effects and safety in clinical practice.

[A pilot study on a specific measure for sleep disorders in Parkinson's disease: SCOPA-Sleep]. / Estudio piloto sobre una medida especifica para los trastornos del sueno de la enfermedad de Parkinson: SCOPA-sueño.

INTRODUCTION: There is a high prevalence of sleep disorders in Parkinson's disease (PD). AIMS. To assess some basic metric attributes of the SCOPA-Sleep scale, a measure for PD patients; secondary objective: to check the impact caused by the sleep disorder on the health-related quality of life (HRQoL) of patients and their caregivers. SUBJECTS AND METHODS: 68 PD patients and their main caregivers; measures: Hoehn and Yahr staging, SCOPA-Motor, Clinical Impression of Severity Index (CISI-PD), PDSS, Hospital Anxiety and Depression Scale, SCOPA-Psychosocial, and EuroQoL. Carers filled in a PDSS questionnaire about patient sleep and HRQoL measures (SF-36, EuroQoL). SCOPA-Sleep acceptability, scaling assumptions, internal consistency, construct validity and precision were determined. RESULTS: SCOPA-Sleep acceptability and scaling assumptions resulted satisfactory, although the nocturnal sleep subescale (SC-Ns) showed a mild ceiling effect (22.1%) and a defective convergent validity was found for daytime sleepiness (SC-Ds) item 6. Internal consistency also was satisfactory for both scales (alpha = 0.84 and 0.75, respectively). The correlation between SC-Ns and PDSS was high (rs = -0.70), as it was between SC-Ns and PDSS questionnaire by caregiver (rs = -0.53). The corresponding coefficients with the SC-Ds gained lower values (rs = -0.41 y -0.50). Standard error of measurement was 1.45 for the SC-Ns and 1.76 for the SC-Ds. Both, patient and caregiver HRQoL showed a loose association with the sleep measures. CONCLUSION: SCOPA-Sleep is a feasible, consistent, and useful scale for assessment of sleep disorder in PD patients. A weak association between sleep disorder and HRQoL was found.

Estudio piloto sobre una medida específica para los trastornos del sueño de la enfermedad de Parkinson: SCOPA-sueño / A pilot study on a specific measure for sleep disorders in parkinson's disease: scopa-sleep

Introducción. En la enfermedad de Parkinson (EP) existe una alta prevalencia de trastornos del sueño. Objetivos. Comprobar los atributos métricos básicos de la escala SCOPA-sueño para pacientes con EP; objetivo secundario: analizar el impacto del trastorno del sueño en la calidad de vida relacionada con la salud(CVRS) del paciente y de su cuidador principal. Sujetos y métodos. 68 pacientes con EP y sus cuidadores principales. Se aplicaron: Hoehn y Yahr, SCOPA-motor, impresión clínica de gravedad (CISIPD),escala PDSS, Hospital Anxiety and Depression Scale, SCOPA-psicosocial y EuroQoL. El cuidador cumplimentó un cuestionario PDSS sobre el sueño del paciente y las medidas de la CVRS(SF-36, EuroQoL). Se analizaron la aceptabilidad, las asunciones escalares, la consistencia interna, la validez de constructo y la precisión de la SCOPA-sueño. Resultados. La SCOPA-sueño mostró aceptabilidad satisfactoria y asunciones escalares. La subescala sueño nocturno (SC-Sn) presentó leve efecto techo (22,1%), y la subescala somnolencia diurna (SC-Sd), defectuosa validez convergente del ítem 6; la consistencia interna de ambas resultó satisfactoria(alfa = 0,84 y 0,75, respectivamente). SC-Sn correlacionó significativamente con la PDSS (rS= –0,70) y con el cuestionario PDSS cumplimentado por el cuidador (rS= –0,53), y fueron menores los valores respectivos para la SC-Sd (rS= –0,41 y –0,50). Error estándar de la medida: SC-Sn, 1,45; SC-Sd, 1,76. La CVRS del pacientey la del cuidador mostraron una escasa correlación con las medidas de sueño. Conclusiones. La escala SCOPA-sueño es viable, consistente y útil para evaluar el trastorno del sueño en pacientescon EP. La relación entre la CVRS y la alteración del sueño fue débil

Introduction. There is a high prevalence of sleep disorders in Parkinson’s disease (PD). Aims. To assess some basicmetric attributes of the SCOPA-Sleep scale, a measure for PD patients; secondary objective: to check the impact caused by thesleep disorder on the health-related quality of life (HRQoL) of patients and their caregivers. Subjects and methods. 68 PDpatients and their main caregivers; measures: Hoehn and Yahr staging, SCOPA-Motor, Clinical Impression of Severity Index(CISI-PD), PDSS, Hospital Anxiety and Depression Scale, SCOPA-Psychosocial, and EuroQoL. Carers filled in a PDSSquestionnaire about patient sleep and HRQoL measures (SF-36, EuroQoL). SCOPA-Sleep acceptability, scaling assumptions,internal consistency, construct validity and precision were determined. Results. SCOPA-Sleep acceptability and scalingassumptions resulted satisfactory, although the nocturnal sleep subescale (SC-Ns) showed a mild ceiling effect (22.1%) and adefective convergent validity was found for daytime sleepiness (SC-Ds) item 6. Internal consistency also was satisfactory forboth scales (alpha = 0.84 and 0.75, respectively). The correlation between SC-Ns and PDSS was high (rS = –0.70), as it wasbetween SC-Ns and PDSS questionnaire by caregiver (rS = –0.53). The corresponding coefficients with the SC-Ds gainedlower values (rS = –0.41 y –0.50). Standard error of measurement was 1.45 for the SC-Ns and 1.76 for the SC-Ds. Both,patient and caregiver HRQoL showed a loose association with the sleep measures. Conclusion. SCOPA-Sleep is a feasible,consistent, and useful scale for assessment of sleep disorder in PD patients. A weak association between sleep disorder andHRQoL was found

Propuesta para un registro clínico de demencias / A proposal for a clinical registry of dementias

Objetivo. Se presenta una propuesta de las característicasestructurales y funcionales necesarias para desarrollar un registrode demencias que permita recoger con garantías de fiabilidady validez la información estandarizada de los casos diagnosticadosde demencia en los centros sanitarios de atención especializada deun área geográfica definida. Desarrollo. Debido a la falta de informaciónsobre los aspectos relativos al impacto de las demenciassobre el sistema sanitario, en términos de utilización de recursos yen patrones de detección, derivación, diagnóstico y tratamiento enla práctica clínica habitual por parte de atención primaria y secundaria,se propone una implementación secuencial del registro paraadaptarse a cada territorio o región sanitaria. En primer lugar, sedeberían identificar los casos y las fuentes de información; en segundolugar, desarrollar un sistema de recogida de datos que permitaadoptar de forma estandarizada la recogida de información yestablecer una estrecha colaboración con los especialistas que llevena cabo el diagnóstico de demencia; y, en tercer lugar, aportar alregistro una estructura logística y de personal que centralice todaslas funciones y actividades del registro. Conclusiones. La vigilanciaepidemiológica es un instrumento fundamental para la planificación,gestión y distribución de los recursos sociosanitarios, para elseguimiento de la evolución natural de enfermedades crónicas asícomo para evaluar el impacto de programas preventivos. En estesentido, y desde un punto de vista funcional, la propuesta de unregistro de demencias cumple todos los requisitos básicos de la vigilanciaepidemiológica

Aims. We outline a proposal for the structural and functional features needed to develop a registry of dementiaswhich can be used to collect standardised information that is both reliable and valid concerning cases of dementia in thespecialised health care centres within a particular geographical area. Development. Due to the shortage of information aboutaspects concerning the impact of dementias on the health care system (in terms of the usage of resources and patterns ofdetection, referral, diagnosis and treatment in usual clinical practice in primary and secondary care), a sequentialimplementation of the registry is proposed so that it can be adapted to each health district or region. The first step is to identifythe cases and sources of information; second, a system for collecting data must be developed that allows information to begathered in a standardised manner while at the same time making it possible to work in close collaboration with thespecialists who diagnose dementia; and, third, it must be set up with the logistics and staff needed to centralise all thefunctions and activities of the registry. Conclusions. Epidemiological surveillance is an essential instrument for planning,managing and distributing community health resources, for following up the natural history of chronic diseases and forassessing the impact of programmes of prevention. In this respect, and from a functional point of view, the proposed registry ofdementias meets all the basic requirements of epidemiological surveillance

[A proposal for a clinical registry of dementias]. / Propuesta para un registro clinico de demencias.

AIMS: We outline a proposal for the structural and functional features needed to develop a registry of dementias which can be used to collect standardised information that is both reliable and valid concerning cases of dementia in the specialised health care centres within a particular geographical area. DEVELOPMENT: Due to the shortage of information about aspects concerning the impact of dementias on the health care system (in terms of the usage of resources and patterns of detection, referral, diagnosis and treatment in usual clinical practice in primary and secondary care), a sequential implementation of the registry is proposed so that it can be adapted to each health district or region. The first step is to identify the cases and sources of information; second, a system for collecting data must be developed that allows information to be gathered in a standardised manner while at the same time making it possible to work in close collaboration with the specialists who diagnose dementia; and, third, it must be set up with the logistics and staff needed to centralise all the functions and activities of the registry. CONCLUSIONS: Epidemiological surveillance is an essential instrument for planning, managing and distributing community health resources, for following up the natural history of chronic diseases and for assessing the impact of programmes of prevention. In this respect, and from a functional point of view, the proposed registry of dementias meets all the basic requirements of epidemiological surveillance.

Análisis de una consulta de Neurología ambulatoria en el área de Rubí, Barcelona / Analysis of an ambulatory Neurology service in the area of Rubí, Barcelona

No disponible

No disponible

Demencia tipo Alzheimer, estudios de correlación cognitivo-funcional y memoria de trabajo. Respuesta / Dementia of Alzheimer type, studies of clinico-functional correlation and working memory. Reply

No disponible

No disponible

[Correlations between cognition and function in Alzheimer's disease: based on the abbreviated Barcelona Test (a-BT)]. / Correlación cognitivo-funcional en la demencia tipo Alzheimer: a propósito del Test Barcelona Abreviado.

INTRODUCTION: The objective is to establish the existence of possible correlations between cognitive measures using the a-BT, and functional measures in a population of normal to moderately severe demented subjects. METHODS: A sample of 107 subjects (42 healthy controls, 19 subjects with mild cognitive impairment and 46 patients with probable Alzheimer's disease) were included in the present study. The instruments of the cognitive measure used was the abbreviated Barcelona Test (a-BT), a test of general cognitive function. Apart from that, the following functional scales, evaluating activities of daily living, were used: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), and Interview for Deterioration in Daily living in Dementia (IDDD). The statistical procedures were the correlations between cognitive and functional measures using Pearson's correlation coefficient. RESULTS: The correlations obtained between the cognitive and all functional measures were all highly significant (p < 0.0001) and consistently high, with correlations ranging between 0.72 and 0.80. Correlations between the a-BT and functional measures of more basic activities of daily living (RDRS-2, BDRS) were lower than those that included instrumental and some advanced activities of daily living (IDDD). DISCUSSION: The present paper establishes the existence of satisfactory correlations between the functional measures studied and the global scores of the a-BT. These correlations are applicable for groups of subjects with cognitive impairment that does not reach the threshold of a diagnosis of dementia as well as subjects suffering from Alzheimer's disease, at least up to moderately severe cases. The global score of the a-BT allows for some degree of prediction of the functional status of a subject with suspected Alzheimer's disease pathology evaluated.