Comparative analysis between the MMSE and the RUDAS for dementia screening in low educated people in a Spanish psychogeriatric clinic

BACKGROUND AND OBJECTIVES: The Mini-Mental State Examination (MMSE) remains the most widely used test for the screening of dementia, but its limitations in low educated people are well known. This justified the development of new scales aimed at rooting out any socio-cultural bias, such as the Rowland Universal Dementia Assessment Scale (RUDAS). The aim of this paper is to compare the accuracy of the Spanish RUDAS and the MMSE for the diagnosis of dementia in a population with low level of education. METHODS: In a Psychogeriatric Unit a total of 97 outpatients were administered the RUDAS (by blinded examiners) and the MMSE (by an expert clinician, blind to the RUDAS results). RESULTS: 35 of the 97 subjects received the diagnosis of dementia. The area under the ROC curve (AUC) for the RUDAS, 0.901 (IC 95% 0.84-0.96) was similar to MMSE AUC 0.889 (IC 95% 0.82-0.95). The ideal cut-off point for the RUDAS was 21/22 with 94.3% sensitivity and 72.6% specificity. The "best" cut point for the MMSE was 16/17, lower than the standard 23/24, with 85.7% sensitivity and 77.4% specificity. The MMSE correlated with educational level (r=0.432, p < 0.01), but the RUDAS did not (r=0.087; n.s.). CONCLUSIONS: The RUDAS was not only as accurate as the MMSE for the screening of dementia, but also, it was found to be free of biases associated withed the education level. Hence, the RUDAS seems to be a more adequate test for dementia screening in our cultural context than the MMSE. These results should be replicated in a primary care setting

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Enfermedad de Parkinson y espectro obsesivo-compulsivo / Parkinson´s disease and obsessive-compulsive spectrum

Introducción. La descripción de la asociación de síntomas obsesivos con trastornos neurológicos ha sentado las bases de los modelos neuroanatómicos del trastorno obsesivo-compulsivo y ha involucrado a los ganglios basales y lóbulos frontales en su etiopatogenia. En la última década se han comunicado frecuentemente en pacientes con enfermedad de Parkinson fenómenos obsesivo-compulsivos –ya sean rasgos o síntomas– y trastornos del control de impulsos –en el otro extremo del espectro–. Se ha postulado que esta asociación constituiría una prueba más del hipotético papel de los ganglios de la base en los circuitos implicados en la aparición de los fenómenos característicos de los trastornos del espectro obsesivo-compulsivo. Objetivos. Se realiza una revisión en Medline con las expresiones ‘obsessive compulsive Parkinson’ e ‘impulse control Parkinson’, con la finalidad de comprobar las evidencias existentes sobre dichas asociaciones. Desarrollo. Parecen existir suficientes datos como para no considerar casual la aparición de novo de trastornos del control de impulsos en enfermos parkinsonianos. Esto se ha relacionado sobre todo con el tratamiento con agonistas dopaminérgicos. Mayor desacuerdo existe sobre la presentación de síntomas obsesivo-compulsivos en la enfermedad de Parkinson, al encontrarse estudios con resultados dispares y con importantes diferencias metodológicas, incluso en la definición del fenómeno obsesivo. Conclusiones. Actualmente son necesarios más estudios que profundicen en esta cuestión y que sean lo más rigurosos posible, por los avances que podría suponer para el conocimiento de la neurobiología de estas entidades (AU)

Introduction. The description of obsessive symptoms associated with neurological diseases are in the basis of the neuroanatomical models of obsessive-compulsive disorder, with participation of basal ganglia and frontal lobes in its ethiopathogenesis. In the last years, the growth of obsessive-compulsive phenomena –including personality features or symptoms– and impulse control disorders –at the other extreme of the spectrum– in patients with Parkinson’s disease were frequently reported. It was proposed that this association could be other proof of the role of basal ganglia in the characteristic features of the obsessive-compulsive spectrum disorders. Aims. A review in Medline was conduced using the expressions ‘obsessive compulsive Parkinson’ and ‘impulse control Parkinson’. The purpose of this review was to compile the current evidence about these associations. Development. There are sufficient data to support that the growth of impulse control disorders in parkinsonian patients are not produced by chance. It was mainly related with the dopaminergic agonist treatments. More controversial is the growth of obsessive-compulsive symptoms in Parkinson’s disease. The studies found have shown contradictory results and important methodological disparities that included even the definition of obsessive phenomenon. Conclusions. Further and more rigorous studies about these topics are needed, because they could produce and important advance in the knowledge of the neurobiology of these entities (AU)

[Parkinson's disease and obsessive-compulsive spectrum]. / Enfermedad de Parkinson y espectro obsesivo-compulsivo.

INTRODUCTION: The description of obsessive symptoms associated with neurological diseases are in the basis of the neuroanatomical models of obsessive-compulsive disorder, with participation of basal ganglia and frontal lobes in its ethiopathogenesis. In the last years, the growth of obsessive-compulsive phenomena -- including personality features or symptoms -- and impulse control disorders -- at the other extreme of the spectrum -- in patients with Parkinson's disease were frequently reported. It was proposed that this association could be other proof of the role of basal ganglia in the characteristic features of the obsessive-compulsive spectrum disorders. AIMS: A review in Medline was conduced using the expressions 'obsessive compulsive Parkinson' and 'impulse control Parkinson'. The purpose of this review was to compile the current evidence about these associations. DEVELOPMENT: There are sufficient data to support that the growth of impulse control disorders in parkinsonian patients are not produced by chance. It was mainly related with the dopaminergic agonist treatments. More controversial is the growth of obsessive-compulsive symptoms in Parkinson's disease. The studies found have shown contradictory results and important methodological disparities that included even the definition of obsessive phenomenon. CONCLUSIONS: Further and more rigorous studies about these topics are needed, because they could produce and important advance in the knowledge of the neurobiology of these entities.

Depresión vascular con síntomas melancólicos: respuesta a terapia electroconvulsiva / Vascular depression with melancholic symptoms: response to electroconvulsive therapy

El concepto de depresión vascular hace referencia a casos de depresión de inicio tardío, con infartos cerebrales en técnicas de imagen y factores de riesgo cardiovascular, con déficit cognitivos y pobre respuesta a fármacos antidepresivos. Se presenta el caso de una mujer de 71 años, sin antecedentes psiquiátricos y con factores de riesgo vascular, que reingresa en una unidad de hospitalización psiquiátrica por depresión melancólica con síntomas psicóticos. La resonancia magnética de la paciente mostró un infarto lacunar subcortical y una ligera leucoaraiosis y presentó déficit cognitivos en las pruebas neuropsicológicas. En los ingresos previos fue refractaria a psicofármacos, respondiendo únicamente a terapia electroconvulsiva (TEC). En este ingreso se aplicó TEC, con remisión de la sintomatología, incluyéndose en programa de TEC de mantenimiento. El concepto de depresión vascular podría explicar las especiales características y evolución del caso

The concept of vascular depression includes cases of late-onset depression, with cerebral infarction observed in imaging modalities and cardiovascular risk factors, with cognitive disabilities and poor response to antidepressant drugs. A case of a 71 year-old woman with no psychiatric background and with vascular risk factors who was re-admitted to a psychiatric hospitalization unit for melancholic depression with psychotic symptoms is presented. The magnetic resonance imaging showed a subcortical lacunar lesion and mild leukoaraiosis lesions and the neuropsychological examinations showed mild cognitive impairments. In the previous admissions the symptoms were refractory to several psychopharmacology strategies, responding only to electroconvulsive therapy (ECT). In this admission she received ECT, with remission of the symptoms, and was included in an ECT maintenance program. The vascular depression concept would explain the special features and outcome of this case

Vascular depression with melancholic symptoms: response to electroconvulsive therapy.

The concept of vascular depression includes cases of late- onset depression, with cerebral infarction observed in imaging modalities and cardiovascular risk factors, with cognitive disabilities and poor response to antidepressant drugs. A case of a 71 year-old woman with no psychiatric background and with vascular risk factors who was re-admitted to a psychiatric hospitalization unit for melancholic depression with psychotic symptoms is presented. The magnetic resonance imaging showed a subcortical lacunar lesion and mild leukoaraiosis lesions and the neuropsychological examinations showed mild cognitive impairments. In the previous admissions the symptoms were refractory to several psychopharmacology strategies, responding only to electroconvulsive therapy (ECT). In this admission she received ECT, with remission of the symptoms, and was included in an ECT maintenance program. The vascular depression concept would explain the special features and outcome of this case.