Utilidad diagnóstica y validez predictiva del uso conjunto de Fototest y Mini-Cog en deterioro cognitivo / Diagnostic accuracy and predictive validity of associated use of Fototest and Mini-Cog in cognitive impairment

Introducción: El Fototest y el Mini-Cog incluyen todos los dominios que debieran formar parte de una evaluación cognitiva. Nuestro objetivo es evaluar la utilidad diagnóstica del uso conjunto de ambos instrumentos para el diagnóstico de deterioro cognitivo (DC). Métodos: Estudio fase iii de evaluación de pruebas diagnósticas con 2 muestras independientes, estudio (448 sujetos), dividida aleatoriamente en 2 dataset (Base 80%, Test 20%), y Externa (61 sujetos). Prueba index: Fototest y Mini-Cog aplicados consecutivamente; prueba de referencia: evaluación cognitiva formal. Se evalúa la UD del uso combinado y escalonado de los modelos simple (Comb-Simple), regresión logística (Comb-RL) y árbol aleatorio (Comb-AA) para identificar DC (GDS ≥ 3). Se realiza un análisis exploratorio en Base seleccionando los criterios que maximizan la exactitud; la evaluación se realiza en las muestras Test y externa mediante un análisis preespecificado con los criterios seleccionados. Resultados: La UD de los modelos combinados en Base (Comb-Simple 88,3 [(88,5-91,4] [exactitud, LI95%-LS95%], Comb-RL 91.6 [88,2-94,3] y Comb-AA 95,2 [92,5-97,2])) es significativamente superior a la de Mini-Cog y Fototest (81,6 [77,1-85,4] y 84,9 [80,8-88,5], respectivamente); estos resultados son replicados en Test (Comb-Simple 88,9 [exactitud], Comb-RL 95,6 y Comb-AA 92,2) y externa (Comb-Simple 91,8, Comb-RL 90,2 y Comb-AA 88,5). La aplicación escalonada mantiene la misma UD pero requiere menos tiempo (197,3 ± 56,7 vs. 233,9 ± 45,2, p < 0,0001). Conclusiones: El uso conjunto del Fototest y el Mini-Cog requiere menos de 4 min y mejora la UD de ambos instrumentos. El uso escalonado es más eficiente porque manteniendo la misma UD requiere menos tiempo de aplicación.(AU)

Introduction: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. Methods: We performed a phase iii diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs. consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. Results: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs. 233.9 s [45.2]; P<.0001). Conclusions: Combined application of the Fototest and Mini-Cog takes less than 4 minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less...(AU)

Diagnostic accuracy and predictive validity of combined use of Fototest and Mini-Cog in cognitive impairment.

INTRODUCTION: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. METHODS: We performed a phase III diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. RESULTS: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs 233.9 s [45.2]; P < .0001). CONCLUSIONS: Combined application of the Fototest and Mini-Cog takes less than 4 minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy.

Normative data for the Fototest from neurological patients with no cognitive impairment.

OBJECTIVES: To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). MATERIAL AND METHODS: We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). RESULTS: We included a sample of 1055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ±â€¯5.3; P10: 28; P5: 27) and free recall (8.5 ±â€¯2.2; 6; 4), total recall (10.0 ±â€¯1.5; 8; 7), and naming fluency scores (18.7 ±â€¯4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ±â€¯0.3 (ß ±â€¯SD) for sex (female), -2.4 ±â€¯0.3 for age (>65), and -1.6 ±â€¯0.4 and 3.3 ±â€¯0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). CONCLUSIONS: We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting.

Valores normativos del Fototest en pacientes neurológicos sin deterioro cognitivo / Normative data for the Fototest from neurological patients with no cognitive impairment

Objetivos: Proporcionar valores normativos del Fototest relativos a pacientes neurológicos sin deterioro cognitivo, que incluyan datos desagregados para cada uno de los dominios que conforman este instrumento (denominación, recuerdo libre, recuerdo total y fluidez de nombres). Material y métodos: Estudio transversal en pacientes neurológicos sin deterioro cognitivo a los que se aplicó el Fototest, registrándose las puntuaciones desagregadas y total. Estudio descriptivo de los resultados totales y desagregados del Fototest estratificados por sexo, edad (< 65/> 65 años) y estudios (< primaria/primaria/> primaria). Resultados: Muestra de 1.055 sujetos con predominio de mujeres (57,1%), mayores de 65 años (60,6%) y con bajo nivel educativo (36,8% sin estudios primarios). La puntuación total del Fototest (34,6 ± 5,3; 28; 27 [media ± DE; P10; P5]), así como las desagregadas para denominación (5,9 ± 0,3; 6; 5), recuerdo libre (8,5 ± 2,2; 6; 4), recuerdo total (10,0 ± 1,5; 8; 7) y fluidez de nombres (18,7 ± 4,9; 13; 12), están influidas por el sexo, la edad y el nivel educativo. Para la puntuación total, los resultados del estudio multivariante son: sexo (mujer) 1,5 ± 0,3 (ß ± EE), edad (> 65 años) −2,4 ± 0,3, estudios < primaria −1,6 ± 0,4 y estudios > primaria 3,3 ± 0,4 (primaria = referencia estudios). Conclusión: Se proporcionan valores normativos (media ± DE, P10; P5) del Fototest para cada uno de los estratos definidos por las variables sexo, edad y estudios tanto para las puntuaciones totales como desagregadas del Fototest, así como una distribución percentual para cada uno de los valores posibles de estas puntuaciones. Estos valores normativos es de esperar que se traduzcan en una mayor eficiencia del Fototest en el ámbito clínico. (AU)

Objectives: To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). Material and methods: We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). Results: We included a sample of 1,055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ± 5.3; P10: 28; P5: 27) and naming (5,9±0,3; 6; 5), free recall (8.5 ± 2.2; 6; 4), total recall (10.0 ± 1.5; 8; 7), and naming fluency scores (18.7 ± 4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ± 0.3 (ß ± SE) for sex (female), −2.4 ± 0.3 for age (> 65), and −1.6 ± 0.4 and 3.3 ± 0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). Conclusion: We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting. (AU)

Diagnostic accuracy and predictive validity of associated use of Fototest and Mini-Cog in cognitive impairment. / Utilidad diagnóstica y validez predictiva del uso conjunto de Fototest y Mini-Cog en deterioro cognitivo.

INTRODUCTION: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. METHODS: We performed a phase iii diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs. consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. RESULTS: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs. 233.9 s [45.2]; P<.0001). CONCLUSIONS: Combined application of the Fototest and Mini-Cog takes less than 4minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy.

Normative data for the Fototest from neurological patients with no cognitive impairment. / Valores normativos del Fototest en pacientes neurológicos sin deterioro cognitivo.

OBJECTIVES: To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). MATERIAL AND METHODS: We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). RESULTS: We included a sample of 1,055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ± 5.3; P10: 28; P5: 27) and naming (5,9±0,3; 6; 5), free recall (8.5 ± 2.2; 6; 4), total recall (10.0 ± 1.5; 8; 7), and naming fluency scores (18.7 ± 4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ± 0.3 (ß ± SE) for sex (female), -2.4 ± 0.3 for age (> 65), and -1.6 ± 0.4 and 3.3 ± 0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). CONCLUSION: We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting.