Síndrome de Collet-Sicard metastásico / Collet-Sicard syndrome caused by metastasis

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Normative and reliability study of Fototest.

INTRODUCTION: The Fototest is a brief cognitive test suitable for illiterate persons, and valid and accurate for detecting cognitive impairment or dementia. Our aim was to conclude the development of this instrument carrying out a normative and reliability study. METHOD: The normative study was performed on a convenience sample of 223 healthy volunteers aged between 20 and 85 years. The test-retest reliability was assessed through a repeated-measures cross-sectional design on a sample of 50 subjects with no cognitive impairment; the inter-rater reliability was determined by the blind assessment of 10 test applications performed by 30 independent observers; in both instances, reliability was expressed as intra-class correlation coefficient. Internal consistency was analysed by Cronbach's alpha coefficient. RESULTS: The results on the Fototest are normally distributed and are not influenced by gender or educational level but they do vary with age. The test-retest reliability of the Fototest was 0.89 (95% CI: 0.81-0.93); the inter-rater reliability, 0.98 (95% CI: 0.96-0.99); and the internal consistency, 0.94. CONCLUSIONS: The Fototest is free from educational influence and shows appropriate test-retest and inter-rater reliabilities, as well as a high internal consistency. Therefore, it is a suitable psychometric instrument to be used in the follow-up of patients with cognitive impairment or dementia, especially in contexts where evaluators are not the same on different occasions, or with patients of low educational level.

Estudio normativo y de fiabilidad del fototest / Normative and reliability study of fototest

Introducción: El Fototest es un test cognitivo breve aplicable a analfabetos, válido y útil para la detección de deterioro cognitivo y demencia. Nuestro objetivo es completar el proceso de desarrollo del instrumento llevando a cabo un estudio normativo y de fiabilidad. Métodos: El estudio normativo se realizó en una muestra de conveniencia de 223 sujetos voluntarios sanos entre 20 y 85 años. La fiabilidad test-retest (Ftr) se evaluó mediante un diseño transversal de medidas repetidas en una muestra de 50 sujetos sin deterioro cognitivo; la fiabilidad interobservador (Fio) se determinó mediante la evaluación a ciegas de 10 aplicaciones del test por 30 observadores independientes; en ambos casos se utilizó el coeficiente de correlación intraclase. La evaluación de la consistencia interna (CI) se llevó a cabo mediante el coeficiente alfa de Cronbach. Resultados: Los resultados del Fototest se distribuyen normalmente y no están influenciados por el sexo ni el nivel educativo, pero sí por la edad. La Ftr del Fototest es 0,89 (IC 95%: 0,81-0,93), la Fio es de 0,98 (IC 95%: 0,96-0,99) y 0,94 la CI. Conclusiones: El Fototest está libre de influencias educativas y tiene una adecuada fiabilidad, tanto Ftr como Fio, y una alta consistencia interna, por tanto, es un instrumento adecuado para ser usado en el seguimiento de pacientes con deterioro cognitivo y demencia sobre todo en entornos en que cambien los evaluadores, en especial en poblaciones con bajo nivel educativo (AU)

Introduction: The Fototest is a brief cognitive test suitable for illiterate persons, and valid and accurate for detecting cognitive impairment or dementia. Our aim was to conclude the development of this instrument carrying out a normative and reliability study.Method: The normative study was performed on a convenience sample of 223 healthy volunteers aged between 20 and 85 years. The test-retest reliability was assessed through a repeated-measures cross-sectional design on a sample of 50 subjects with no cognitive impairment; the inter-rater reliability was determined by the blind assessment of 10 test applications performed by 30 independent observers; in both instances, reliability was expressed as intra-class correlation coefficient. Internal consistency was analysed by Cronbach's alpha coefficient.Results: The results on the Fototest are normally distributed and are not influenced by gender or educational level but they do vary with age. The test-retest reliability of the Fototest was 0.89 (95% CI: 0.81-0.93); the inter-rater reliability, 0.98 (95% CI: 0.96-0.99); and the internal consistency, 0.94. Conclusions: The Fototest is free from educational influence and shows appropriate test-retest and inter-rater reliabilities, as well as a high internal consistency. Therefore, it is a suitable psychometric instrument to be used in the follow-up of patients with cognitive impairment or dementia, especially in contexts where evaluators are not the same on different occasions, or with patients of low educational level (AU)

Utilidad diagnóstica del Test de las Fotos (Fototest) en deterioro cognitivo y demencia / Diagnostic accuracy of the Phototest for cognitive impairment and dementia

Introducción. El Test de las Fotos (Fototest) es un testrecientemente descrito, fácil, simple y muy breve (<3 min),con ventajas teóricas sobre los tests de cribado de demenciadisponibles. Nuestro objetivo es evaluar su utilidad diagnósticaen condiciones de práctica clínica habitual. Material y métodos. Estudio transversal en fase II de validaciónde pruebas diagnósticas en una muestra de 308 pacientesatendidos en la consulta de neurología general enriquecidacon 70 sujetos sanos. Se evaluó la utilidad diagnóstica (UD)del Fototest y se comparó con la del Eurotest y un test defluencia verbal (TFV) frente al diagnóstico clínico de demencia(DEM) y deterioro cognitivo (DET) mediante el cálculodel área bajo la curva ROC (aROC) y la determinación de losvalores de sensibilidad (S), especificidad (E) y cocientes deprobabilidad (CP). Resultados. La muestra total estaba compuesta por225 sujetos sin deterioro cognitivo (NOR), 58 con DET sinDEM y 95 DEM; los resultados del Fototest en los sujetosNOR se distribuyen normalmente (33,4±3,9 [media±desviaciónestándar]) y no están influenciados por variables educativas.La UD del Fototest para DEM y DET (0,95±0,01 [aROC±ee]) es similar a la del Eurotest y ambas superiores a las delTFV. El punto de corte 25/26 para DEM (S=0,88 [0,80-0,94]y E=0,90 [0,86-0,93]) y 28/29 para DET (S=0,90 [0,84-0,94] yE=0,90 [0,83-0,93]) maximizan la suma de S y E. Conclusiones. El Fototest es un test muy breve, fácil,aplicable a analfabetos, no influenciado por variables educativasy útil para la identificación de DET y DEM en la prácticaclínica cotidiana

Introduction. The recently developed Phototest is asimple, easy and very brief (<3 minutes) test with theoreticaladvantages over available dementia screeningtests. Our objective was to evaluate its diagnostic accuracyunder routine clinical conditions. Material and methods. A phase II cross-sectionalvalidation study of diagnostic tests was performed in asample of 308 patients referred to a general neurologydepartment and in a group of 70 healthy individuals.The diagnostic accuracy (DA) of the Phototest was assessedand compared with that of the Eurotest and a verbalfluency test (VFT) in relation to the clinical diagnosis ofdementia (DEM) and cognitive impairment (CI) by calculatingthe area under the ROC curve (aROC) and determiningSensitivity (Se), Specificity (Sp) and likelihood ratios. Results. The total sample comprised 225 subjects withoutCI (NOR), 58 with CI and without DEM and 95 withDEM. Phototest results showed a normal distribution inNOR subjects (33.4 ± 3.9 [mean ± standard desviation])and were not influenced by educational variables. TheDA of the Phototest for DEM and CI (0.95 ± 0.01[aROC±Se]) was similar to that of the Eurotest and higherfor both tests than that of the VFT. The cutoff pointsof 25/26 for DEM (Se=0.88 [0.80-0.94], Sp=0.90 [0.86-0.93]) and 28/29 for CI (Se=0.90 [0.84-0.94], Sp=0.90[0.83-0.93]) maximised the sum of Se and Sp. Conclusions. The Phototest is a very short test ofeasy application that is applicable to illiterate subjects,uninfluenced by educational variables and useful toidentify CI and DEM in routine clinical practice

[Diagnostic accuracy of the Phototest for cognitive impairment and dementia]. / Utilidad diagnóstica del Test de las Fotos (Fototest) en deterioro cognitivo y demencia.

INTRODUCTION: The recently developed Phototest is a simple, easy and very brief (<3 minutes) test with theoretical advantages over available dementia screening tests. Our objective was to evaluate its diagnostic accuracy under routine clinical conditions. MATERIAL AND METHODS: A phase II cross-sectional validation study of diagnostic tests was performed in a sample of 308 patients referred to a general neurology department and in a group of 70 healthy individuals. The diagnostic accuracy (DA) of the Phototest was assessed and compared with that of the Eurotest and a verbal fluency test (VFT) in relation to the clinical diagnosis of dementia (DEM) and cognitive impairment (CI) by calculating the area under the ROC curve (aROC) and determining Sensitivity (Se), Specificity (Sp) and likelihood ratios. RESULTS: The total sample comprised 225 subjects without CI (NOR), 58 with CI and without DEM and 95 with DEM. Phototest results showed a normal distribution in NOR subjects (33.4 +/- 3.9 [mean +/- standard desviation]) and were not influenced by educational variables. The DA of the Phototest for DEM and CI (0.95 +/- 0.01 [aRO C+/- Se]) was similar to that of the Eurotest and higher for both tests than that of the VFT. The cutoff points of 25/26 for DEM (Se=0.88 [0.80-0.94], Sp=0.90 [0.86- 0.93]) and 28/29 for CI (Se=0.90 [0.84-0.94], Sp=0.90 [0.83-0.93]) maximised the sum of Se and Sp. CONCLUSIONS: The Phototest is a very short test of easy application that is applicable to illiterate subjects, uninfluenced by educational variables and useful to identify CI and DEM in routine clinical practice.

[Impact of warning against procrastination of thrombolysis in ischemic stroke]. / Impacto de las advertencias contra la procrastinación sobre las demoras en la trombólisis del ictus.

INTRODUCTION: Fibrinolysis in stroke should be carried out as soon as possible, but delays occur for various reasons. In the first 17 ischemic infarcts treated in our center we confirmed a tendency to exhaust the therapeutic window. We look now at whether warnings against this tendency, without other logistical or organizational modifications, have had an impact on delays. PATIENTS AND METHODS: Neurologists were encouraged to avoid procrastination. When we reached 51 treated patients, we compared features and delay times between the first 17 (February, 2002 to June, 2004) and the 17 most recent cases (October, 2005 to April, 2006). Non-parametric tests were used (significant if p < 0.05). RESULTS: Both groups were similar clinically and demographically. The onset-arrival time lengthened (46 min vs. 75 min; p = 0.01) and scattered. The CT-treatment time halved (57 min vs. 30 min; p = 0.001), with consequent shortening of the 'door-to-needle' period (121 min vs. 90 min; p = 0.002). The arrival-CT time had remained constant (50 min vs. 53 min; p = 0.9), thus the total delay from onset did not change significantly (165 min vs. 170 min; p = 0.7), and the inverse linear correlation between the onset-CT time and the CT-treatment time weakened. CONCLUSIONS: Warnings against procrastination appear to be important in terms of shortening the delays. The time used for clinical-radiologic evaluation (arrival through CT)--about which there had been no action taken--had not been modified, but the time employed in the decision to treat (CT-treatment) and the 'door-to-needle' time had decreased appreciably. This effective compensatory reduction permitted treatment of late-arriving patients, such that although the overall time from onset to treatment apparently was not modified, the actual treatment rate increased.

Impacto de las advertencias contra la procrastinación sobre las demoras en la trombólisis del ictus / Impact of warning against procrastination of thrombolysis in ischemic stroke

Introducción. La fibrinólisis del ictus isquémico debe llevarse a cabo cuanto antes; conocer las causas de retraso permite su eventual corrección. En los primeros 17 casos que tratamos comprobamos que tendía a agotarse el período de ventana terapéutica; evaluamos si las advertencias frente a ello, sin otras modificaciones logísticas u organizativas, han tenido impacto en las demoras. Pacientes y métodos. Se estimuló la celeridad en el tratamiento. Con 51 pacientes tratados, comparamos características y tiempos de demora en los primeros 17 casos (febrero de 2002 a junio de 2004) y en los 17 más recientes (octubre de 2005 a abril de 2006), utilizando tests no paramétricos (significación si p < 0,05). Resultados. Ambos grupos son similares demográfica y clínicamente. El tiempo inicio-puerta se alargó (46 min frente a 75 min; p = 0,01) y dispersó. El tiempo entre tomografía axial computarizada (TAC) y tratamiento se redujo a la mitad (57 min frente a 30 min; p = 0,001), con el consecuente acortamiento del período ‘puerta-aguja’ (121 min frente a 90 min; p = 0,002). El tiempo puerta-TAC se mantuvo constante (50 min frente a 53 min; p = 0,9), y la demora total desde el inicio tampoco se modificó significativamente (165 min frente a 170 min; p = 0,7); la correlación lineal inversa entre tiempo de inicio-TAC y tiempo TAC-tratamiento perdió intensidad. Conclusiones. Las advertencias contra la procrastinación parecen haber sido eficaces para abreviar la toma de decisión de tratar (TAC-tratamiento) y el tiempo ‘puerta-aguja’, mientras que el tiempo utilizado en la evaluación clinicorradiológica (puerta-TAC), sobre el que no había habido actuaciones, no se modificó. Ello ha permitido realizar fibrinólisis a pacientes que llegan más tarde; así, aunque el tiempo inicio-tratamiento aparentemente no cambió, se incrementó la tasa de fibrinólisis

Introduction. Fibrinolysis in stroke should be carried out as soon as possible, but delays occur for various reasons. In the first 17 ischemic infarcts treated in our center we confirmed a tendency to exhaust the therapeutic window. We look now at whether warnings against this tendency, without other logistical or organizational modifications, have had an impact on delays. Patients and methods. Neurologists were encouraged to avoid procrastination. When we reached 51 treated patients, we compared features and delay times between the first 17 (February, 2002 to June, 2004) and the 17 most recent cases (October, 2005 to April, 2006). Non-parametric tests were used (significant if p < 0.05). Results. Both groups were similar clinically and demographically. The onset-arrival time lengthened (46 min vs. 75 min; p = 0.01) and scattered. The CTtreatment time halved (57 min vs. 30 min; p = 0.001), with consequent shortening of the ‘door-to-needle’ period (121 min vs. 90 min; p = 0.002). The arrival-CT time had remained constant (50 min vs. 53 min; p = 0.9), thus the total delay from onset did not change significantly (165 min vs. 170 min; p = 0.7), and the inverse linear correlation between the onset-CT time and the CT-treatment time weakened. Conclusions. Warnings against procrastination appear to be important in terms of shortening the delays. The time used for clinical-radiologic evaluation (arrival through CT) –about which there had been no action taken– had not been modified, but the time employed in the decision to treat (CT-treatment) and the ‘door-to-needle’ time had decreased appreciably. This effective compensatory reduction permitted treatment of late-arriving patients, such that although the overall time from onset to treatment apparently was not modified, the actual treatment rate increased