Inter-Rater Agreement in the Clinical Diagnosis of Cognitive Status: Data from the Neurological Disorders in Central Spain 2 Pilot Study.

BACKGROUND: To assess the diagnostic agreement of cognitive status (dementia, mild cognitive impairment (MCI), normal cognition) among neurologists in the field of neurological disorders in Central Spain 2 study. METHODS: Full medical histories of 30 individuals were provided to 27 neurologists: 9 seniors, 10 juniors and 8 residents. For each case, we were asked to assign a diagnosis of dementia, MCI or normal cognition using the National Institute on Aging-Alzheimer's Association workgroup (NIA-AA) core clinical criteria for all-cause dementia, Winblad et al. criteria for MCI, and analyze intensity and etiology if dementia was diagnosed. Inter-rater agreement was assessed both with percent concordance and non-weighted κ statistics. RESULTS: Overall inter-rater agreement on cognitive status was κ = 0.76 (95% CI 0.65-0.86), being slightly higher among junior neurologists (κ = 0.85, 95% CI 0.73-0.95) than among seniors (κ = 0.71, 95% CI 0.59-0.83) and residents (κ = 0.69, 95% CI 0.54-0.81) but without statistical significance among groups. Dementia severity showed an overall κ of 0.34, 0.44 and 0.64 for mild, moderate and severe dementia respectively. CONCLUSIONS: Substantial agreement was demonstrated for the diagnosis of cognitive status (dementia, MCI and normal cognition) among neurologists of different levels of experience in a population-based epidemiological study using NIA-AA and Winblad et al. CRITERIA: The agreement rate was lower in the diagnosis of dementia severity.

Embolismo cerebrocerebral: un camino desconocido en el ictus isquémico / Brain-to-brain embolism: an unknown pathway to consider in ischemic strokes

No disponible

Versiones en español del Minimental State Examination (MMSE). Cuestiones para su uso en la práctica clínica / Spanish versions of the Minimental State Examination (MMSE). Questions for their use in clinical practice

El Minimental State Examination (MMSE), creado en 1975 como instrumento para la evaluación breve del estado mental, ha tenido una gran difusión, y es el test cognitivo más citado en Medline y con mayor número de versiones idiomáticas (superiores a 70). Este artículo pretende, mediante una revisión en la base de datos Medline, analizar sus virtudes y limitaciones, además de precisar su utilidad clínica actual, tanto de la versión original como de sus modificaciones, principalmente de las adaptaciones al español. El MMSE (original o versiones) es el test más utilizado para la evaluación cognitiva estandarizada en el ámbito clínico, sobre todo en el anciano. Es el que dispone de más datos para el cribado, estadiaje y seguimiento de las demencias. Sin embargo, dado que su cumplimentación puede requerir más de 10 minutos, ha de competir con tests de cribado más cortos y específicos en atención primaria y el medio comunitario. En el ámbito hospitalario y especializado, se precisan evaluaciones neuropsicológicas estandarizadas más amplias que permitan detectar alteraciones cognitivas sutiles en pacientes con demencia incipiente o alteración cognitiva leve, además de establecer un perfil cognitivo de los diferentes subtipos de demencias. Este trabajo realiza una serie de recomendaciones sobre el uso clínico de las versiones españolas del MMSE en diferentes contextos de aplicación (AU)

The Minimental State Examination (MMSE), created in 1975 as a tool for briefly evaluating the patient’s mental state, has been widely used and is the most frequently cited cognitive test on Medline, as well as being the one with the most versions in different languages (over 70). Through a review of the Medline database, this paper aims to analyse its virtues and shortcomings, in addition to determining its current clinical usefulness, in both the original version and any of its modifications, although here we are mainly concerned with its Spanish adaptations. The MMSE (original or versions) is the most commonly used test for standardised cognitive assessment in the clinical setting, especially in the case of the elderly. It is the test with the most data for screening, staging and monitoring dementias. Yet, because filling it in may take over 10 minutes, it has to compete with shorter, more specific screening tests in the primary care and community setting. In the hospital and specialised setting, there is a need for broader standardised neuropsychological tests that make it possible to detect subtle cognitive disorders in patients with incipient dementia or mild cognitive impairment, as well as to establish a cognitive profile of the different subtypes of dementia. This study proposes a series of recommendations on the clinical use of the Spanish versions of the MMSE in different contexts of application (AU)

Ptosis fluctuante como presentación del síndrome de hipotensión licuoral espontánea / Fluctuating ptosis as the presenting symptom of spontaneous liquoral hypotension syndrome

No disponible

[Fluctuating ptosis as the presenting symptom of spontaneous liquoral hypotension syndrome]. / Ptosis fluctuante como presentación del síndrome de hipotensión licuoral espontánea.

TITLE: Ptosis fluctuante como presentacion del sindrome de hipotension licuoral espontanea.