Evaluación cognitiva global en personas vascoparlantes con demencia en estadios avanzados. Validación al euskera de la escala Severe Mini Mental State Examination (SMMSE-eus) / Overal cognitive assessment in Basque-speaking people with advanced dementia. Validation to the Basque language of the Severe Mini-Mental State Examination SMMSE (SMMSE-eus)

Introducción: La adaptación y validación al euskera de pruebas para la evaluación del deterioro cognitivo avanzado es una necesidad no cubierta para personas mayores vascoparlantes. El presente trabajo realiza el estudio de validación al euskera de la escala Severe Mini Mental State Examination (SMMSE-eus). Material y métodos: En el estudio participaron 109 sujetos con demencia avanzada (MEC<15) clasificados según la escala de Deterioro global (GDS) con GDS 5-7 y que dominaban tanto el euskera como el castellano. Resultados: Los resultados mostraron que el SMMSE-eus muestra una alta consistencia interna (α=0,92), una buena fiablidad test-restest (r=0,88; p<0,01) y una alta fiabilidad interjueces (CCI=0,99; p<0,00) tanto para la puntuación global como para cada uno de los ítems. Conclusiones: Tanto la alta consistencia interna como el alto nivel de fiabilidad interjueces y los resultados obtenidos en el test-retest hacen del SMMSE-eus un instrumento apropiado como escala breve en la valoración del deterioro cognitivo grave de personas vascoparlantes. Por ello el SMMSE-eus puede ser considerado válido, fiable y una alternativa importante para evaluar en su lengua materna, en este caso en euskera, la capacidad cognitiva en personas con demencia avanzada

Introduction: Adaptation and validation to the Basque language of tests to assess advanced cognitive impairment is a not covered need for Basque-speaking people. The present work shows the validation of the Basque version of the Severe Mini Mental State Examination (SMMSE). Material and methods: A total of 109 people with advanced dementia (MEC<15) took part in the validation study, and were classified as GDS 5-7 on the Geriatric Depression Scale (GDS). All participants were Spanish-Basque bilingual. Results: It was shown that SMMSE-eus has a high internal consistency (alpha=0.92), a good test-retest reliability (r=0.88; P<.01), and a high inter-rater reliability (CCI=0.99; P<.00) for the overall score, as well as for each item. Conclusions: Both the high internal consistency and inter-rater reliability, and to a lesser extent, test-retest reliability, made the SMMSE-eus a valid test for the brief assessment of cognitive status in people with advanced dementia in Basque-speaking people. For this reason, the SMMSE-eus is a usable and reliable alternative for assessing Basque-speaking people in their mother-tongue, or preferred language

[Overal cognitive assessment in Basque-speaking people with advanced dementia. Validation to the Basque language of the Severe Mini-Mental State Examination SMMSE (SMMSE-eus)]. / Evaluación cognitiva global en personas vascoparlantes con demencia en estadios avanzados. Validación al euskera de la escala Severe Mini Mental State Examination (SMMSE-eus).

INTRODUCTION: Adaptation and validation to the Basque language of tests to assess advanced cognitive impairment is a not covered need for Basque-speaking people. The present work shows the validation of the Basque version of the Severe Mini Mental State Examination (SMMSE). MATERIAL AND METHODS: A total of 109 people with advanced dementia (MEC<15) took part in the validation study, and were classified as GDS 5-7 on the Geriatric Depression Scale (GDS). All participants were Spanish-Basque bilingual. RESULTS: It was shown that SMMSE-eus has a high internal consistency (alpha=0.92), a good test-retest reliability (r=0.88; P<.01), and a high inter-rater reliability (CCI=0.99; P<.00) for the overall score, as well as for each item. CONCLUSIONS: Both the high internal consistency and inter-rater reliability, and to a lesser extent, test-retest reliability, made the SMMSE-eus a valid test for the brief assessment of cognitive status in people with advanced dementia in Basque-speaking people. For this reason, the SMMSE-eus is a usable and reliable alternative for assessing Basque-speaking people in their mother-tongue, or preferred language.

Adaptación y validación de la versión española de la escala de evaluación de dolor en personas con demencia avanzada: PAINAD-Sp / Adaptation and validation of the Spanish version of the Pain Evaluation Scale in patients with advanced dementia: PAINAD-Sp

Introducción. El dolor está considerado como un grave problema en el entorno residencial afectando entre un 49 y un 83% de los residentes. El proceso evolutivo de la enfermedad de Alzheimer puede conllevar dificultades de comunicación y comprensión de las escalas de evaluación de dolor, dificultando su evaluación y tratamiento. El objetivo principal de este estudio fue validar la versión española del PAINAD (PAINAD-Sp) y evaluar su aplicabilidad en un Centro Gerontológico en España. Material y métodos. Veinte usuarias diagnosticadas de demencia avanzada fueron observadas por 5 observadores con diferentes perfiles profesionales durante 5 min en 3 condiciones: reposo, durante actividad agradable y en situación de dolor. La PAINAD-Sp fue administrada simultáneamente a una escala analógica visual. Resultados. Los resultados muestran que el alfa de Cronbach se encontraba entre 0,467 y 0,827 (con una media de 0,692, que subía si el ítem de respiración se eliminaba). La fiabilidad interjueces variaba entre 0,587 y 0,956. La correlación entre la medida total en PAINAD-Sp y en una Escala Visual Analógica fue estadísticamente significativa (p < 0,05) en todas las medidas y variaba entre 0,517 y 0,868. Conclusiones. Los resultados del estudio muestran que la escala PAINAD-Sp es eficaz para medir el dolor en personas con demencia sin capacidad de comunicación. Esta escala puede ser usada por diferentes profesionales de la salud con poco entrenamiento y presenta una buena fiabilidad (AU)

Introduction. Pain in elderly people is considered a major concern in nursing home facilities affecting between 49% and 83% of the residents. Progression of Alzheimer's Disease causes more communication difficulties in patients with advanced dementia and therefore more problems to understand even the most simple pain evaluation scales. Identification and implementation of appropriate pain management strategies depends on an adequate pain assessment. Material and methods. The main objective of the study was to validate the Spanish version of the PAINAD Scale (PAINAD-Sp) and to assess its applicability in Spanish Geriatric Nursing Homes. The 20 patients diagnosed with severe dementia from a Geriatric Centre in Spain were observed by five observers with different professional profiles for 5 minutes to each participant, and PAINAD-Sp Scale was administered simultaneously to a Visual Analogical Scale-VAS. Three different observational conditions were established: resting condition, during presumably pleasant activity and during presumable painful activity. Results. Cronbach's alpha ranged between 0.467 and 0.827 (average 0.692), and rose if Breathing item was deleted. Inter-rater reliability ranged between 0.587 and 0.956. Correlation between PAINAD-Sp Scale total measures and VAS was statistically significant (P<.05) in all measures and ranged from 0.517 to 0.868. Conclusions. Findings in the study showed that the scale is useful to measure pain in non communicative patients suffering from dementia. The scale maintains good levels of reliability for different healthcare professionals even when they have little training (AU)

[Adaptation and validation of the Spanish version of the Pain Evaluation Scale in patients with advanced dementia: PAINAD-Sp]. / Adaptación y validación de la versión española de la escala de evaluación de dolor en personas con demencia avanzada: PAINAD-Sp.

INTRODUCTION: Pain in elderly people is considered a major concern in nursing home facilities affecting between 49% and 83% of the residents. Progression of Alzheimer's Disease causes more communication difficulties in patients with advanced dementia and therefore more problems to understand even the most simple pain evaluation scales. Identification and implementation of appropriate pain management strategies depends on an adequate pain assessment. MATERIAL AND METHODS: The main objective of the study was to validate the Spanish version of the PAINAD Scale (PAINAD-Sp) and to assess its applicability in Spanish Geriatric Nursing Homes. The 20 patients diagnosed with severe dementia from a Geriatric Centre in Spain were observed by five observers with different professional profiles for 5 minutes to each participant, and PAINAD-Sp Scale was administered simultaneously to a Visual Analogical Scale-VAS. Three different observational conditions were established: resting condition, during presumably pleasant activity and during presumable painful activity. RESULTS: Cronbach's alpha ranged between 0.467 and 0.827 (average 0.692), and rose if Breathing item was deleted. Inter-rater reliability ranged between 0.587 and 0.956. Correlation between PAINAD-Sp Scale total measures and VAS was statistically significant (P<.05) in all measures and ranged from 0.517 to 0.868. CONCLUSIONS: Findings in the study showed that the scale is useful to measure pain in non communicative patients suffering from dementia. The scale maintains good levels of reliability for different healthcare professionals even when they have little training.

Evaluación breve del estado cognitivo de la demencia en estadios avanzados: resultados preliminares de la validación española del Severe Mini-Mental State Examination / Short evaluation of cognitive state in advanced stages of dementia: preliminary results of the Spanish validation of the Severe Mini-Mental State Examination

Introducción. La evaluación cognitiva de pacientes con demencias avanzadas es una necesidad no cubierta de forma adecuada, por lo que es necesario desarrollar herramientas que permitan obtener información del estado cognitivo y los recursos con los que aún cuentan estos sujetos. El presente trabajo realiza el estudio de validación al castellano de la escala Severe Mini-Mental State Examination (SMMSE). Material y métodos. Participaron 47 sujetos con demencia avanzada (Mini-Examen Cognoscitivo [MEC] < 11), evaluados con las escalas Global Deterioration Scale de Reisberg, MEC, SMMSE y Severe Cognitive Impairment Profile. Resultados. Todos los ítems que componen la prueba mostraron una buena capacidad de diferenciación. La prueba mostró una alta consistencia interna (α=0,88), y buena fiabilidad test-retest (0,64-1,00; p<0,01) e interjueces (0,69-1,00; p<0,01), tanto para la puntuación total como para cada uno de los ítems. La validez de constructo se analizó mediante la correlación con el MEC (r=0,59; p<0,01). Además, se dividió la muestra entre sujetos con MEC 0-5 y MEC>5, hallando que la correlación entre las puntuaciones en SMMSE y MEC era significativa en el grupo de MEC 0-5 (r=0,55; p<0,05), mientras que no lo era en aquellos con MEC>5. Asimismo se encontraron diferencias de puntuación en SMMSE, pero no en MEC, entre los tres grupos de GDS (5, 6 y 7) (H=11,1; p<0,05). Conclusiones. El SMMSE es un instrumento de evaluación del deterioro cognitivo avanzado que amplía el rango inferior de medida del MEC evitando el «efecto suelo». A partir de nuestros resultados el instrumento puede ser considerado válido y fiable, así como rápido y fácil de administrar(AU)

Introduction. The cognitive assessment of patients with advanced dementia needs proper screening instruments that allow obtain information about the cognitive state and resources that these individuals still have. The present work conducts a Spanish validation study of the Severe Mini Mental State Examination (SMMSE). Material and methods. Forty-seven patients with advanced dementia (Mini-Cognitive Examination [MEC]<11) were evaluated with the Reisberg's Global Deterioration Scale, MEC, SMMSE and Severe Cognitive Impairment Profile scales. Results. All test items were discriminative. The test showed high internal (α=0.88), test-retest (0.64 to 1.00, P<.01) and between observers reliabilities (0.69-1.00, p<0.01), both for scores total and for each item separately. Construct validity was tested through correlations between the instrument and MEC scores (r=0.59, P< 0 .01). Further information on the construct validity was obtained by dividing the sample into groups that scored above or below 5 points in the MEC and recalculating their correlations with SMMSE. The correlation between the scores in the SMMSE and MEC was significant in the MEC 0-5 group (r=0.55, P<.05), but not in the MEC>5 group. Additionally, differences in scores were found in the SMMSE, but not in the MEC, between the three GDS groups (5, 6 and 7) (H=11.1, P<.05). Conclusions. The SMMSE is an instrument for the assessment of advanced cognitive impairment which prevents the floor effect through an extension of lower measurement range relative to that of the MEC. From our results, this rapid screening tool and easy to administer, can be considered valid and reliable(AU)

[Short evaluation of cognitive state in advanced stages of dementia: preliminary results of the Spanish validation of the Severe Mini-Mental State Examination]. / Evaluación breve del estado cognitivo de la demencia en estadios avanzados: resultados preliminares de la validación española del Severe Mini-Mental State Examination.

INTRODUCTION: The cognitive assessment of patients with advanced dementia needs proper screening instruments that allow obtain information about the cognitive state and resources that these individuals still have. The present work conducts a Spanish validation study of the Severe Mini Mental State Examination (SMMSE). MATERIAL AND METHODS: Forty-seven patients with advanced dementia (Mini-Cognitive Examination [MEC]<11) were evaluated with the Reisberg's Global Deterioration Scale, MEC, SMMSE and Severe Cognitive Impairment Profile scales. RESULTS: All test items were discriminative. The test showed high internal (α=0.88), test-retest (0.64 to 1.00, P<.01) and between observers reliabilities (0.69-1.00, p<0.01), both for scores total and for each item separately. Construct validity was tested through correlations between the instrument and MEC scores (r=0.59, P<0.01). Further information on the construct validity was obtained by dividing the sample into groups that scored above or below 5 points in the MEC and recalculating their correlations with SMMSE. The correlation between the scores in the SMMSE and MEC was significant in the MEC 0-5 group (r=0.55, P<.05), but not in the MEC>5 group. Additionally, differences in scores were found in the SMMSE, but not in the MEC, between the three GDS groups (5, 6 and 7) (H=11.1, P<.05). CONCLUSIONS: The SMMSE is an instrument for the assessment of advanced cognitive impairment which prevents the floor effect through an extension of lower measurement range relative to that of the MEC. From our results, this rapid screening tool and easy to administer, can be considered valid and reliable.