Performance on the Latin American version of the Face-Name Associative Memory Exam (LAS-FNAME) distinguishes individuals with Mild Cognitive Impairment from age-matched controls in a sample from Argentina.

INTRODUCTION: The Latin American Spanish version of the Face-Name Associative Memory Exam (LAS-FNAME) has shown promise in identifying cognitive changes in those at risk for Alzheimer's disease (AD). However, its applicability for Mild Cognitive Impairment (MCI) detection in the Latin American population remains unexplored. This study aims to analyze the psychometric properties in terms of validity and reliability and diagnostic performance of the LAS-FNAME for the detection of memory disorders in patients with amnestic MCI (aMCI). MATERIALS AND METHODS: The study included 31 participants with aMCI, diagnosed by a neurologist according to Petersen's criteria, and 19 healthy controls. Inclusion criteria for the aMCI group were to be 60 years of age or older, report cognitive complaints, have a memory test score (Craft Story 21) below a -1.5 z-score and have preserved functioning in activities of daily living. Participants completed LAS-FNAME and a comprehensive neuropsychological assessment. RESULTS: LAS-FNAME showed the ability to discriminate against healthy controls from patients with aMCI (AUC= 75) in comparison with a gold-standard memory test (AUC = 69.1). LAS-FNAME also showed evidence of concurrent and divergent validity with a standard memory test (RAVLT) (r = 0.58, p < .001) and with an attention task (Digit Span) (r = -0.37, p = .06). Finally, the reliability index was very high (α = 0.88). DISCUSSION: LAS-FNAME effectively distinguished aMCI patients from healthy controls, suggesting its potential for detecting early cognitive changes in Alzheimer's prodromal stages among Spanish speakers.

Long-term trajectories of densely reported depressive symptoms during an extended period of the COVID-19 pandemic in Switzerland: Social worries matter.

Previous mental health trajectory studies were mostly limited to the months before access to vaccination. They are not informing on whether public mental health has adapted to the pandemic. The aim of this analysis was to 1) investigate trajectories of monthly reported depressive symptoms from July 2020 to December 2021 in Switzerland, 2) compare average growth trajectories across regions with different stringency phases, and 3) explore the relative impact of self-reported worries related to health, economic and social domains as well as socio-economic indicators on growth trajectories. As part of the population-based Corona Immunitas program of regional, but harmonized, adult cohorts studying the pandemic course and impact, participants repeatedly reported online to the DASS-21 instrument on depressive symptomatology. Trajectories of depressive symptoms were estimated using a latent growth model, specified as a generalised linear mixed model. The time effect was modelled parametrically through a polynomial allowing to estimate trajectories for participants' missing time points. In all regions level and shape of the trajectories mirrored those of the KOF Stringency-Plus Index, which quantifies regional Covid-19 policy stringency. The higher level of average depression in trajectories of those expressing specific worries was most noticeable for the social domain. Younger age, female gender, and low household income went along with higher mean depression score trajectories throughout follow-up. Interventions to promote long-term resilience are an important part of pandemic preparedness, given the observed lack of an adaptation in mental health response to the pandemic even after the availability of vaccines in this high-income context.

Trajectories of depression, anxiety and stress among adults during the COVID-19 pandemic in Southern Switzerland: the Corona Immunitas Ticino cohort study.

OBJECTIVES: Using longitudinal data from Southern Switzerland we assessed ten-month temporal trajectories of moderate to severe depression, anxiety and stress among adults after the first pandemic wave and explored differences between sociodemographic and health status groups. STUDY DESIGN: This was a population-based prospective cohort study. METHODS: Participants were 732 (60% women) adults aged 20-64 years who completed the Depression, Anxiety and Stress Scale on a monthly base since August 2020 until May 2021, as part of the Corona Immunitas Ticino study based on a probability sample of non-institutionalized residents in Ticino, Southern Switzerland. RESULTS: Prevalence of moderate to severe depression increased from 7.5% in August 2020 to 12.5% in May 2021, anxiety increased from 4.8% to 8.1% and stress increased from 5.5% to 8.8%. A steeper increase in poor mental health was observed between October 2020 and February 2021. Men had a lower risk for anxiety (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.36-0.95) and stress (OR = 0.61, 95% CI = 0.44-0.95) than women. Suffering from a chronic disease increased the risk for depression (OR = 1.82, 95% CI = 1.12-2.96), anxiety (OR = 2.38, 95% CI = 1.44-3.92) and stress (OR = 1.87, 95% CI = 1.14-3.08). The differences between these groups did not vary over time. CONCLUSIONS: In a representative Swiss adult sample, prevalence of moderate to severe depression, anxiety and stress almost doubled in the course of ten months following the end of the first pandemic wave in spring 2020. Women and participants with pre-existing chronic conditions were at a higher risk of poor mental health.

Deterioro cognitivo y conducción de automóviles / Cognitive impairment and automobile driving

INTRODUCCIÓN El crecimiento de la expectativa de vida genera un aumento en la cantidad de personas mayores que continúan manejando automóviles. Asimismo, la edad es un factor de riesgo para el desarrollo de demencia. Si bien los pacientes con demencia leve son conductores de alto riesgo, un alto porcentaje de ellos puede manejar adecuadamente. OBJETIVOS Identificar las pruebas cognitivas que mejor predicen las habilidades de conducción vehicular en personas mayores de 65 años. MÉTODOS Un total de 28 sujetos mayores de 65 años con licencia de conducir vigente y demencia leve y 28 controles sanos fueron sometidos a una batería neuropsicológica y una evaluación de manejo vehicular, que incluyó una prueba en un simulador y un test de conducción en una pista. RESULTADOS Los pacientes se desempeñaron significativamente peor en la evaluación cognitiva y en la evaluación de manejo vehicular. Las pruebas cognitivas que correlacionaron con todos los subtests de la Evaluación de Manejo Vehicular y que probaron ser más sensibles al manejo riesgoso fueron la fluencia verbal semántica, el Trail Making Test B y la Escala de Detección de Olvidos. Otras pruebas cognitivas también correlacionaron con la evaluación de manejo en pista, pero únicamente con algunos de los subtests del simulador. Estas pruebas fueron Mini Mental State Examination, Logical Memory, Trail Making Test A, Test Dígito símbolo, Boston Naming Test, Lista Auditivo Verbal de Rey, copia de la Figura de Rey Osterrieth, Frontal Assessment Battery, Inventario Neuropsiquiátrico abreviado (NPI-Q) y Cuestionario de Actividad Funcional (FAQ). DISCUSIÓN Las pruebas cognitivas que correlacionaron con la evaluación vehicular podrían resultar útiles para predecir la capacidad de manejo en sujetos mayores de 65 años.

Relevancia del efecto de posición serial en el diagnóstico diferencial entre el deterioro cognitivo leve, la demencia de tipo Alzheimer y el envejecimiento normal / Relevance of the serial position effect in the differential diagnosis of mild cognitive impairment, Alzheimer-type dementia, and normal ageing

Los efectos de posición serial son estudiados cuando se memoriza una serie de palabras que excede el span atencional. En sujetos normales son recordadas más frecuentemente las palabras del inicio y final de una lista reflejando el funcionamiento de la memoria episódica a corto y largo plazo. Objetivos: Estudiar el efecto de principio y el de fin de lista en pacientes con deterioro cognitivo leve (DCL) y compararlo con demencia tipo Alzheimer (DTA) y sujetos con envejecimiento normal (SN). Métodos: Fueron evaluados neurológica y neuropsicológicamente 30 pacientes con DTA, 25 con DCL y 20 SN. Se utilizó el Test de aprendizaje auditivo de una lista de palabras de Rey en donde se evaluó el efecto de principio, medio y fin de lista en cada ensayo y su efecto en el recuerdo diferido. Resultados: Los sujetos con DCL mostraron un patrón general de memoria similar a los sujetos con DTA, caracterizado por una reducción en el aprendizaje, olvido acelerado y un claro efecto de fin de lista en el aprendizaje. A nivel del recuerdo diferido mostraron un patrón diferencial recordando palabras de principio y medio más cercano a los normales pero no recordando las finales de la lista como las DTA. Conclusiones: La prueba de aprendizaje de una lista de palabras es una herramienta que nos permite discriminar entre pacientes con DCL y SN. El índice de recencia en el recuerdo diferido es un indicador útil para diferenciar el envejecimiento normal de los pacientes con DCL (AU)

Serial position effects are observed when a person memorises a series of words exceeding his or her attention span. Cognitively normal individuals recall words at the beginning and end of the list more frequently than those in the middle, which reflects the way that short- and long-term episodic memory works. Objective: To study the serial position effect in patients with mild cognitive impairment (MCI) compared to subjects with Alzheimer-type dementia (AD) or normal ageing (NA). Methods: 30 AD, 25 MCI and 20 NA subjects underwent neurological and neuropsychological assessment. The Rey Auditory Verbal Learning Test (RAVLT) was used to study primacy, middle, and recency effects and delayed recall for each group. Results: The general memory pattern of MCI subjects was very similar to that of AD subjects, and was characterised by reduced learning capacity, rapid forgetfulness and clear recency effect in learning. With regard to delayed recall, however, there were differences in performance; MCI subjects’ ability to recall words at the beginning and middle of the list was similar to that of normal subjects, while their memory of words at the end of the list was poor, as in AD subjects. Conclusions: RAVLT is a tool permitting us to distinguish between MCI and NA subjects. The recency index for the delayed recall task is a valid indicator for distinguishing between MCI patients and patients with normal ageing (AU)

Relevance of the serial position effect in the differential diagnosis of mild cognitive impairment, Alzheimer-type dementia, and normal ageing.

UNLABELLED: Serial position effects are observed when a person memorises a series of words exceeding his or her attention span. Cognitively normal individuals recall words at the beginning and end of the list more frequently than those in the middle, which reflects the way that short- and long-term episodic memory works. OBJECTIVE: To study the serial position effect in patients with mild cognitive impairment (MCI) compared to subjects with Alzheimer-type dementia (AD) or normal ageing (NA). METHODS: 30 AD, 25 MCI and 20 NA subjects underwent neurological and neuropsychological assessment. The Rey Auditory Verbal Learning Test (RAVLT) was used to study primacy, middle, and recency effects and delayed recall for each group. RESULTS: The general memory pattern of MCI subjects was very similar to that of AD subjects, and was characterised by reduced learning capacity, rapid forgetfulness and clear recency effect in learning. With regard to delayed recall, however, there were differences in performance; MCI subjects' ability to recall words at the beginning and middle of the list was similar to that of normal subjects, while their memory of words at the end of the list was poor, as in AD subjects. CONCLUSIONS: RAVLT is a tool permitting us to distinguish between MCI and NA subjects. The recency index for the delayed recall task is a valid indicator for distinguishing between MCI patients and patients with normal ageing.

[Validity of the Spanish version of the Addenbrooke's Cognitive Examination for the diagnosis of dementia and to differentiate Alzheimer's disease and frontotemporal dementia]. / El Addenbrooke's Cognitive Examination en español para el diagnóstico de demencia y para la diferenciación entre enfermedad de Alzheimer y demencia frontotemporal.

INTRODUCTION: The Addenbrooke's Cognitive Examination (ACE) is a brief bedside test battery to detect mild dementia and differentiate frontotemporal dementia (FTD) from Alzheimer's disease (AD). AIM: To validate the ACE in Spanish. PATIENTS AND METHODS: The study evaluated the Spanish version of ACE on 128 subjects consisting in two groups a patient group (n = 76) and a control subjects group (n = 52). The patient group was divided in AD (n = 54) based on the NINCDS-ADRDA criteria and FTD (n = 22) based on the Lund y Manchester criteria. All patients underwent clinical, neuropsychological, radiologic (MRI, CT, and SPECT), and laboratory evaluations. Group's differences were evaluated using ANOVA. The internal consistency of the Spanish version of the ACE was measured using the Cronbach's alpha coefficient. The discriminative capability of the Spanish version of the ACE was examined by the receiver operating characteristic (ROC) analysis. RESULTS: The cut-off score of 86 showed a sensitivity of 92% (CI 95% = 83.6-97.0) and a specificity of 96.2% (CI 95% = 86.8-99.4). The ROC curve showed higher sensitivity and specificity of the ACE than the Mini-Mental State Examination in discriminating the dementia and control group. The VLOM ratio (verbal fluency + language)/(orientation + memory) of < 1.82 discriminated for FTD and > 4.87 discriminated for AD. CONCLUSION: The Spanish version of ACE is a brief and reliable instrument for early detection of dementia in highly educated people and offers a simple objective index to differentiate AD and FTD. More studies in less educated people are warranted.

El Addenbrooke’s Cognitive Examination en español para el diagnóstico de demencia y para la diferenciación entre enfermedad de Alzheimer y demencia frontotemporal / Validity of the spanish version of the addenbrooke’s cognitive examination for the diagnosis of dementia and to differentiate alzheimer’s disease and frontotemporal dementia

Introducción. Existe una creciente necesidad de contar con un instrumento breve y fiable que permita detectar demencia en los estadios iniciales. Objetivo. Validar la traducción al español del Addenbrooke’s Cognitive Examination (ACE), una batería breve recientemente desarrollada y validada en inglés para detectar demencia y diferenciar la demencia tipo Alzheimer (DTA) de la demencia frontotemporal (DFT). Pacientes y métodos. Se estudiaron los siguientes grupos: controles (n = 52), DFT según criterios del consenso de Lund y Manchester (n = 22) y pacientes con probable DTA (n = 54) según criterios del NINCDS-ADRDA. A todos los pacientes se les realizó una batería neuropsicológica estándar, inventarios neuropsiquiátricos y neuroimágenes. La diferencia entre grupos se evaluó con ANOVA y la consistencia interna del cuestionario mediante el coeficiente α de Cronbach. La elección del punto de corte se realizó mediante la curva ROC (del inglés receiver operating characteristics). Resultados. El test mostró una aceptable coherencia interna. El cut-off de 86 arrojó una sensibilidad del 92% (IC 95%: 83,6-97,0) y especificidad del 96,2% (IC 95%: 86,8-99,4). La curva ROC demostró mayor sensibilidad y especificidad del ACE sobre el Mini-Mental State Examination para discriminar entre grupo control y demencia. El coeficiente VLOM (fluidez verbal + lenguaje) / (orientación + recuerdo diferido) permite orientar el diagnóstico hacia DFT si el valor es menor de 1,82 y hacia DTA si es mayor de 4,87. Conclusión. La versión en español del ACE posee buena especificidad y sensibilidad para la detección de demencia en población de alto nivel educativo y permite orientar el diagnóstico diferencial entre DFT y DTA. Se necesitan nuevos estudios en población de menor escolaridad

Introduction. The Addenbrooke’s Cognitive Examination (ACE) is a brief bedside test battery to detect mild dementia and differentiate frontotemporal dementia (FTD) from Alzheimer’s disease (AD). Aim. To validate the ACE in Spanish. Patients and methods. The study evaluated the Spanish version of ACE on 128 subjects consisting in two groups a patient group (n = 76) and a control subjects group (n = 52). The patient group was divided in AD (n = 54) based on the NINCDS-ADRDA criteria and FTD (n = 22) based on the Lund y Manchester criteria. All patients underwent clinical, neuropsychological, radiologic (MRI, CT, and SPECT), and laboratory evaluations. Group’s differences were evaluated using ANOVA. The internal consistency of the Spanish version of the ACE was measured using the Cronbach’s alpha coefficient. The discriminative capability of the Spanish version of the ACE was examined by the receiver operating characteristic (ROC) analysis. Results. The cut-off score of 86 showed a sensitivity of 92% (CI 95% = 83.6-97.0) and a specificity of 96.2% (CI 95% = 86.8-99.4). The ROC curve showed higher sensitivity and specificity of the ACE than the Mini-Mental State Examination in discriminating the dementia and control group. The VLOM ratio (verbal fluency + language) / (orientation + memory) of 4.87 discriminated for AD. Conclusion. The Spanish version of ACE is a brief and reliable instrument for early detection of dementia in highly educated people and offers a simple objective index to differentiate AD and FTD. More studies in less educated people are warranted

Modeling cross-border care in the EU using a principal-agent framework.

Cross-border care is likely to become a major issue among EU countries because patients have the option of obtaining treatment abroad under Community Regulations 1408/71. This paper develops a model formalizing both the patient's decision to apply for cross-border care and the authorizing physician's decision to admit a patient to the program. The patient is assumed to maximize expected utility, which depends on the quality of care and the length of waiting in the home country and the host country, respectively. Not all patients qualifying for the EU program present themselves to the authorizing physician because of the transaction cost involved. The physician in her turn shapes effective demand for authorization through her rate of refusal, which constitutes information to potential applicants about the probability of obtaining treatment abroad. The authorizing physician thus acts as an agent serving two principals, her patient and her national government, trading off the perceived utility loss of patients who are rejected against her commitment to domestic health policy. The model may be used to explain existing patient flows between EU countries.