A novel abbreviated version of the Luria neuropsychological diagnosis battery: reliability and convergent validity in Spanish older adults.

OBJECTIVE: To estimate the test-retest and inter-rater reliability of the new Spanish abbreviated version of the Luria Neuropsychological Diagnosis (DNA-2) battery for older adults. METHOD: A total of thirty cognitively healthy volunteers were examined in this study. The participants completed a comprehensive standardized assessment, encompassing cognitive and functional performance. Intraclass correlation coefficients (ICC) were used to examine test-retest and inter-rater reliability. One month was allowed between administrations. Furthermore, correlations between Luria DNA-2 (total and domain subscores) and other classical cognitive measures were explored. RESULTS: The test-retest reliability on the overall Luria DNA-2 score was high (ICC= .834, 95% CI [.680, .917], p < .001). Furthermore, the inter-rater reliability for the total score demonstrated an excellent concordance between administrators (ICC= .990, 95% CI [.979, .995], p < .001). Positive and significant correlations were observed between Luria DNA-2 (both total and domain subscores) and the Addenbrooke's Cognitive Examination (ACE-III; ρ = .857, p < .001). CONCLUSIONS: This study supports the adequate reliability of the Luria DNA-2, as an abbreviated neuropsychological battery, for assessing cognitive performance in Spaniards aged 55 years and older. Future studies should continue to explore the psychometric properties of the Luria DNA-2, particularly those related to its diagnostic validity for early detection of cognitive impairment.

Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights.

Dementia remains an underdiagnosed syndrome, and there is a need to improve the early detection of cognitive decline. This narrative review examines the role of neuropsychological assessment in the characterization of cognitive changes associated with dementia syndrome at different states. The first section describes the early indicators of cognitive decline and the major barriers to their identification. Further, the optimal cognitive screening conditions and the most widely accepted tests are described. The second section analyzes the main differences in cognitive performance between Alzheimer's disease and other subtypes of dementia. Finally, the current challenges of neuropsychological assessment in aging/dementia and future approaches are discussed. Essentially, we find that current research is beginning to uncover early cognitive changes that precede dementia, while continuing to improve and refine the differential diagnosis of neurodegenerative disorders that cause dementia. However, neuropsychology faces several barriers, including the cultural diversity of the populations, a limited implementation in public health systems, and the adaptation to technological advances. Nowadays, neuropsychological assessment plays a fundamental role in characterizing cognitive decline in the different stages of dementia, but more efforts are needed to develop harmonized procedures that facilitate its use in different clinical contexts and research protocols.

Estudio retrospectivo de pacientes derivados de cuidados intensivos pediátricos a cuidados paliativos: por qué y para qué / Retrospective study of children referred from paediatric intensive care to palliative care: Why and for what

Introducción: La creación de Unidades de Cuidados Paliativos Pediátricos (UCPP) podría optimizar el manejo de niños que tras ingreso en la unidad de cuidados intensivos pediátricos (UCIP) requieren enfoque paliativo. Este trabajo describe las características clínico-epidemiológicas de pacientes derivados por este hecho a la UCPP de la Comunidad Autónoma de Madrid (CAM). Se detallan el tratamiento global requerido, las reagudizaciones, los ingresos hospitalarios y las condiciones del fallecimiento, si se produjo. Pacientes y método: Estudio retrospectivo mediante revisión de historias clínicas de pacientes derivados desde las diferentes UCIP de la CAM a la UCPP (1 de marzo del 2008-31 de enero del 2015). Resultados: Se incluye a 41 pacientes (26 varones/15 mujeres, mediana de edad de 33 meses, rango de 1-228). En seguimiento por la UCPP son los abordajes principales el respiratorio (ventilación invasiva con traqueostomía 8/41), nutricional (20/41 gastrostomía) y farmacológico (29/41 anticomiciales y 34/41antibioterapia). El tiempo de seguimiento fue de 232 días (rango 1-1.164). Requieren ingreso hospitalario 11/41, sin reingresos en UCIP. Fallecen 13/41 pacientes de los cuales 9/13 lo hacen en domicilio, todos acompañados por los cuidadores principales y solo en 1/9 con presencia del equipo domiciliario. Conclusiones: El enfoque paliativo domiciliario de niños con ingreso en intensivos y dependientes de tecnología es posible. Se requiere hospitalización domiciliaria que no deriva en todos los casos en el fallecimiento del paciente. La integración de UCPP podría así optimizar el cuidado integral de pacientes previamente críticos, siendo necesarios trabajos observacionales, prospectivos y multicéntricos para confirmar esto (AU)

Introduction: The creation of paediatric palliative care units (PPCU) could optimise the management of children with palliative focus after admission to a paediatric intensive care unit (PICU). This study describes the clinical and epidemiological characteristics of children referred from PICU to the PPCU of the Autonomous Community of Madrid (CAM). The overall treatment, relapses, re-admissions, and deaths, if occurred, are described. Patients and method: A retrospective review was performed using the medical records from children transferred from the CAM paediatric intensive care units to the paediatric palliative care unit (1 March 2008-31 January 2015). Results: A total of 41 patients were included (26 male/15 female) with a median age of 33 months (range 1-228). In the follow by the PPCU follow-up, the main approaches were respiratory (invasive ventilation with tracheostomy tube 8/41), nutritional (gastrostomy in 20/41), and pharmacological (anti-epileptics in 29/41 and 34/41 on antibiotic treatment). Hospital re-admission was required by 11/41 patients, with no re-admissions to PICU. Of the 13/41 patients who died, 9/13 was at home, with all of them accompanied by the primary caregivers and family, and only 1/9 with the presence of the home team. Conclusions: The palliative approach at home is feasible in children, and the integration of PPCU could optimise the comprehensive care of previously critically ill children. It is necessary to achieve an optimal domiciliary care should be achieved, and not just because of patient death. More observational, multicentre and prospective studies are needed to confirm these findings (AU)

Cuidados Paliativos Pediátricos / No disponible

No disponible

¿Sufren deterioro cognitivo los ancianos sin enfermedades cerebrales? Datos de la cohorte NEDICES / Do the elderly people without brain diseases suffer cognitive impairment? Data from the NEDICES cohort

Objetivo: evaluar el cambio cognitivo durante 3 años en los participantes del estudio NEDICES (acrónimo de Neurological Disorders in Central Spain) sin enfermedades neurológicas. Población y métodos: la cohorte NEDICES es un estudio poblacional censal que incluye a 5278 personas mayores (con una edad igual o mayor de 65 años). Para este estudio se seleccionaron participantes sin enfermedades neurológicas y que habían realizado el Mini-Mental State Examination-37 (MMSE-37) en dos cortes (1994-1995 y 1997-1998). El cambio cognitivo se calculó mediante las diferencias (DIF) en la puntuación obtenida en el MMSE-37 en ambos cortes. Según la variable DIF, la muestra se estratificó en tres grupos: con declive cognitivo (pérdida de más de 3 puntos), sin cambio cognitivo (DIF no superior a 3 puntos en valor absoluto), y mejora cognitiva (ganancia de más de 3 puntos). Se estableció una comparación de variables relevantes (médicas y psicosociales) entre los tres grupos mediante análisis de varianza y la prueba de la chi-cuadrado. Resultados: cumplieron los criterios de inclusión 2039 participantes, con una edad media de 72,2 años (desviación estándar [DE] = 5,7). La variable DIF se distribuyó normalmente y conllevó un decremento mínimo (media [M] = -0,8 puntos; DE = 3,6). El grupo de declive cognitivo estuvo integrado por 433 sujetos (22 %), el grupo sin cambio por 1311 (64 %) y el de mejora por 275 (13 %). No se encontraron diferencias significativas entre los grupos en comorbilidad ni salud subjetiva; el grupo con declive cognitivo tenía más edad, menor nivel de estudios, hacía menos ejercicio, sufría un leve declive en las actividades instrumentales, y probablemente esté integrado mayoritariamente por casos de deterioro cognitivo leve (MCI, del inglés mild cognitive impairment). Conclusión: el declive cognitivo en los participantes seleccionados fue poco relevante; el grupo con deterioro cognitivo debe estar integrado mayoritariamente por casos de MCI incidentes (AU)

Objective: To assess the cognitive change along three years of the NEDICES (Neurological disorders in Central Spain) participants. Population and methods: The NEDICES cohort is a census population-based study integrated by 5278 elderly (65 years and older). For this study, participants with MMSE-37 and without neurological illnesses in two waves (1994-5 y 1997-8) were selected. The cognitive change of individuals was calculated by the differences (DIF) on MMSE37 scores in both waves. According to the DIF, the sample was stratified in three groups: cognitive decline group (loss > three points in MSSE-37), group without cognitive change (change no higher than three points in absolute value) and cognitive improvement group (gain > three points). The three groups were compared in relevant medical and psychosocial variables by means of analysis of variance and chi-square test. Results: 2039 (mean age = 72.21; SD = 5.72) participants met the criteria for inclusion in the study. The variable DIF showed a normal distribution and had a minimal decrement (mean = -0.8; SD = 3.63). The cognitive decline group was integrated by 433 (22 %) subjects, the group without cognitive change by 1331 (64 %), and the group of cognitive improvement by 275 (13 %). No significant differences among groups were found in comorbidities or subjective health. The cognitive decline group was more aged, less educated, performed less physical exercise, suffered slight worsening in instrumental activities and probably was highly integrated by cases of mild cognitive impairment (MCI). Conclusion: The selected participants had an insignificant cognitive decline; the cognitive decline group probably is mainly integrated by MCI cases (AU)

Posibilidades terapéuticas en la epilepsia refractaria en el complejo esclerosis tuberosa / Therapeutic possibilities in refractory epilepsy in tuberous sclerosis complex

Objetivo. Describir las características epidemiológicas, clínicas y el tratamiento de los pacientes afectos de CET con epilepsia. Pacientes y métodos. Se han revisado retrospectivamente las historias clínicas de 30 pacientes menores de 18 años, diagnosticados de CET y epilepsia registrados en nuestra base de datos. Resultados. La edad de inicio de la epilepsia en los pacientes con CET en nuestra serie está comprendida entre el primer mes de vida y los 4 años. Todos comenzaron con crisis parciales. Dos presentaron síndrome de West y cuatro, espasmos infantiles sin hipsarritmia. En 19 de los pacientes, la epilepsia se comportó como farmacorresistente. Respecto al tratamiento con fármacos antiepilépticos, 11 están en monoterapia, 10 en biterapia, siete en triterapia y uno con cuatro fármacos. Dos recibieron ACTH, dos tienen implantado un estimulador del nervio vago, cuatro reciben tratamiento con everolimus y ocho han sido sometidos a cirugía. Conclusiones. La epilepsia es un problema muy frecuente y de inicio en los primeros años de vida en el CET. Las opciones terapéuticas actuales son muchas, sin embargo el 63,3% de los pacientes tiene una epilepsia no controlada y la mayoría de ellos presenta crisis diarias. El mal control de las crisis se correlaciona con retraso mental y trastorno del espectro autista. Señalar la respuesta positiva obtenida con otras posibilidades terapéuticas: inhibidores de la vía mTOR, cirugía y el estimulador del nervio vago (AU)

Introduction. Tuberous sclerosis complex (TSC) is frequently accompanied by difficult-to-treat epilepsy, which conditions these patients’ quality of life and cognitive level. Aim. To describe the epidemiological and clinical characteristics, as well as the treatment of patients affected by TSC with epilepsy. Patients and methods. A retrospective review was carried out of the medical records of 30 patients aged under 18 registered in our database, who had been diagnosed with TSC and epilepsy. Results. The age at onset of epilepsy in the patients with TSC in our series ranged from one month to four years. All of them began with partial crises. Two presented West’s syndrome and four others had infantile spasms without hypsarrhythmia. In 19 of the patients, the epilepsy was medication resistant. As regards treatment with antiepileptic drugs, 11 are in monotherapy, 10 in bitherapy, seven in tritherapy and one with four drugs. Two were given ACTH, two carry an implanted vagal nerve stimulator, four receive treatment with everolimus and eight have undergone surgery. Conclusions. Epilepsy is a very common problem and begins in the early years of life in TSC. There are currently a large number of therapeutic options available, although 63.3% of patients have non-controlled epilepsy and most of them present crises on a daily basis. Poor control of their crises is correlated with mental retardation and autism spectrum disorder. The positive response obtained with other therapeutic possibilities, such as mTOR pathway inhibitors, surgery and vagal nerve stimulator, should be noted (AU)

Fiabilidad interobservador y test-retest de una versión española (MMSE-37) del test minimental de Folstein, adaptada a poblaciones de bajo nivel educativo / Test-retest and interobserver reliability of a Spanish version (MMSE-37) of the Folstein minimental test, adapted to populations with a low level of schooling

Introducción. Existen varias versiones en español del test minimental de Folstein (MMSE, Minimental State Examination); una es el MMSE de 37 puntos (MMSE-37), que está adaptado a personas de bajo nivel cultural. Objetivo. Estudiar la fiabilidad interobservador y test-retest del MMSE-37. Pacientes y métodos. La fiabilidad interobservador se estudió en tres observadores profesionales que realizaron simultáneamente el MMSE-37 en 40 pacientes de ámbito comunitario. La fiabilidad test-retest se obtuvo en 35 pacientes mediante la realización del MMSE-37 en dos ocasiones en un plazo de 2-3 meses. Estadísticos utilizados: coeficiente de correlación intraclase (CCI), método de acuerdo de Bland y Altman, e índice kappa. Resultados. Estudio de fiabilidad interobservador: CCI múltiple de 0,99 (intervalo de confianza del 95%, IC 95% = 0,99- 0,99); índice kappa de 0,84 (IC 95% = 0,72-0,97); el grado de acuerdo existente entre las respuestas individuales fue de 1 para ‘resultado patológico’, 0,79 para ‘resultado probablemente patológico’, 0,37 para ‘resultado probablemente normal’ y 0,89 para ‘resultado normal’; CCI > 0,99 (IC 95% = 0,99-0,99) entre todos los pares de observadores. Las diferencias sistemáticas en la puntuación media entre las parejas de observadores no superó la puntuación de 0,1, lo que implica un 0,47% de sesgo una vez eliminada la escala. Estudio de fiabilidad test-retest: CCI de 0,92 (IC 95% = 0,87-0,96), índice kappa de 0,84 (IC 95% = 0,54-1,00) y diferencia media en la magnitud del desacuerdo de 0,34 (IC 95% = –2,80-3,49), un 1% del error porcentual en la magnitud del desacuerdo. Conclusiones. El MMSE-37 muestra alta fiabilidad entre observadores profesionales y test-retest como en otras versiones del MMSE (AU)

Introduction. Several versions of Folstein’s minimental test (MMSE, Minimental State Examination) exist in Spanish. One of them is the 37-point MMSE (MMSE-37), which is adapted to people with a low cultural level. Aims. To study the interobserver and test-retest reliability of the MMSE-37. Patients and methods. Interobserver reliability was studied in three professional observers who simultaneously administered the MMSE-37 to 40 patients from a community setting. Test-retest reliability was obtained in 35 patients by administering the MMSE-37 on two occasions 2-3 months apart. Statistics used: intraclass correlation coefficient (ICC), Bland-Altman difference plot method, and kappa index. Results. Interobserver reliability study: multiple ICC of 0.99 (95% confidence interval, CI 95% = 0.99-0.99); kappa index of 0.84 (CI 95% = 0.72-0.97); the degree of agreement between the individual responses was 1 for ‘pathological outcome’, 0.79 for ‘probably pathological outcome’, 0.37 for ‘probably normal outcome’ and 0.89 for ‘normal outcome’; ICC > 0.99 (CI 95% = 0.99-0.99) between all the pairs of observers. The systematic differences in the mean score between the pairs of observers did not exceed the score of 0.1, which represents a bias of 0.47% after removing the scale. Test-retest reliability study: ICC of 0.92 (CI 95% = 0.87-0.96), kappa index of 0.84 (CI 95% = 0.54-1.00) and mean difference in the magnitude of disagreement of 0.34 (CI 95% = –2.80-3.49), 1% of the percent error in the magnitude of the disagreement. Conclusions. The MMSE-37 shows a high degree of test-retest reliability and reliability among professional observers, as in other versions of the MMSE (AU)