Test Your Memory is sensitive to cognitive change but lacks prospective validity.

OBJECTIVE: To determine the prospective validity of Test Your Memory (TYM) and its sensitivity to change in cognitive state. METHODS: This longitudinal prospective study followed 71 patients with subjective cognitive symptoms and 48 with mild cognitive impairment for a mean time period of 35.2 ± 15 months. Subjects did not have dementia or depression at the beginning of follow-up and each participant was given the TYM at least two times. A psychometric threshold was established to determine presence of a cognitive deficit (z-score ≤ 1.5 on at least one cognitive domain) and the Disability Assessment for Dementia scale was used to ensure full functional ability. The criterion for deterioration was a change in the stage on the Global Deterioration Scale. RESULTS: Sixty-one patients remained cognitively stable and 58 worsened. There were no differences between them with respect to sex, educational attainment, the initial stage on the GDS, or the score on the first TYM. Subjects who worsened were older than those who did not. The TYM increased an average of 0.04 points per month in patients who remained stable or improved (95% CI, -0.01 to 0.08) and decreased an average of 0.14 points per month in those whose condition worsened (95% CI, -0.19 to -0.09). Subjects with mild cognitive impairment who worsened displayed a sharper loss of TYM points than did subjects with subjective cognitive symptoms. CONCLUSIONS: While the TYM lacks prospective validity, it is sensitive to changes in cognitive state.

Validation of a Spanish version of the Test Your Memory.

OBJECTIVE: To validate a Spanish version of the TYM, a self-administered cognitive screening test designed for the detection of Alzheimer's disease and mild cognitive defect. METHODS: A cross-sectional study was conducted in a neurology outpatient clinic. The TYM was administered to individuals of 50 years o more who came to the clinic for whatever the symptom. Their cognitive state was evaluated regardless of the outcome of TYM. They were categorized into 3 groups: 1) Cognitively normal (739), 2) with mild cognitive impairment (183), 3) with dementia (127). An analysis of items was made and the psychometric properties of the TYM were defined. There was a cross-validation, and the predictive validity of the TYM score, adjusted to the demographic variables, was determined by evaluating their performance in ROC curves. RESULTS: The internal consistency, interobserver reliability, short term and long-term test-retest reliability were adequate. The TYM correlated with the MMSE (r=0.779, P<.0001). The cross validation showed consistent results. With the TYM Score adjusted according to the educational level, a sensitivity of 0.86 with a specificity of 0.88 in the cut-off point of ≤40/50 was obtained to identify subjects with cognitive impairment, and a sensitivity of 0.94 with a specificity of 0.89 in the cut-off point of ≤36/50 to identify subjects with dementia. CONCLUSIONS: The TYM is a self-administered global cognitive test, possessing excellent psychometric properties and good predictive validity. It can be used as a cognitive screening test in subjects with 4 years or more of formal education.

[Standardization of the Test Your Memory and evaluation of their concordance with the outcome of the psychometric examination]. / Normalización del Test Your Memory y evaluación de su concordancia con los resultados del examen psicométrico.

OBJECTIVE: To explore the relationship between scores on the Test Your Memory (TYM) battery and findings from a more exhaustive neurocognitive assessment. METHODS: The TYM and fourteen psychometric tests were administered to 84 subjects aged 50 or older who attended an outpatient neurology clinic due to cognitive symptoms. Each patient's cognitive state was determined independently from his/her score on the TYM (CDR 0, n=25; CDR 0.5, n=45; CDR 1, n=14). We analysed concurrent validity of TYM scores and results from the psychometric tests, as well as the degree of concordance between the two types of measurement, by contrasting normalised data from each instrument. RESULTS: Although the intraclass correlation coefficient was 0.67 (confidence interval 95%, 0.53-0.77), analysis of the Bland-Altman plot and the curve on the survival-agreement plot (Luiz et al. method) demonstrates that the individual distances between the two methods exhibit excessive dispersion from a clinical viewpoint. TYM-based predictions of the mean z-score on psychometric tests differed substantially from real results in 30% of the subjects. Concordance of 95% can only be achieved by accepting absolute inter-instrument differences of up to 0.87 as identical values. Furthermore, the TYM underestimates cognitive performance for low values and overestimates it for high values. CONCLUSIONS: The TYM is a cognitive screening test which should not be used to predict results on psychometric tests or to detect cognitive changes in clinical trials.

[Risk factors in atherothrombotic cerebral infarct. Are there differential risk profiles in extensive cortical infarct and lacunar infarct? A case-control study]. / Los factores de riesgo en el infarto cerebral aterotrombótico. Hay perfiles de riesgo diferenciados entre el infarto extenso cortical y el infarto lacunar? Un estudio de casos y controles.

A study of cases and controls was performed to define the factors associated with nonembolic cerebral infarction and to compare the risk profiles of extensive cortical infarction (ECI) to those of lacunar infarction (LI). One hundred and four patients with ECI were matched with 71 patients with LI and with 90 controls. Although the initial analysis disclosed multiple factors associated with cerebral infarction, the analysis with control of the factors revealed that the only factors related with the occurrence of atherothrombotic infarction were: arterial hypertension [odds ratio (OR) = 6.8], diabetes mellitus (OR = 5.6), ischemic cardiac disease (OR = 5.5), increased hematocrit value (OR = 3.0), and atherogenic lipids in patients without arterial hypertension nor diabetes. Diabetes appeared as the only factor specifically associated with LI when compared with ECI (OR = 2.1). This study supports the following conclusions: 1) the risk profile of nonembolic cerebral infarction is concise and intelligible, 2) the possible role of arterial hypertension in the genesis of LI was not confirmed, and 3) diabetic microangiopathy may be implicated in the genesis of most of LI. Conclusions from this retrospective study should be taken as an interpretation of the results since some restriction in the sensitivity of the data analysis was deliberately introduced.

Validación de una versión española del Test Your Memory / Validation of a Spanish version of the Test Your Memory

Objetivo: Validar una versión en español del TYM, una prueba cognitiva de cribado autoadministrada, diseñada para la detección de la enfermedad de Alzheimer y defecto cognitivo ligero. Métodos: Realizamos un estudio transversal en una clínica ambulatoria neurológica. El TYM fue administrado a todas las personas de 50 años o más que acudieron a la consulta, sin tener en cuenta el síntoma por el que consultaban. Independientemente del resultado del TYM se evaluó su estado cognoscitivo. Se clasificaron en 3 grupos: 1) cognitivamente normales (739), 2) con deterioro cognitivo leve (183) y 3) con demencia (127). Se analizaron los ítems y se definieron las propiedades psicométricas del TYM. También se procedió a una validación cruzada y se determinó la validez predictiva del TYM, corregido por las variables demográficas, mediante la evaluación de su desempeño en curvas ROC. Resultados: La consistencia interna, fiabilidad interobservador y fiabilidad test-retest a corto y largo plazo fueron adecuadas. El TYM está correlacionado con el MMSE (r = 0,779; p < 0,0001). La validación cruzada mostró resultados consistentes. Con la puntuación TYM ajustada por nivel educativo, se obtuvo una sensibilidad de 0,86 con una especificidad de 0,88 en el punto de corte de ≤ 40/50 para identificar a sujetos con defecto cognitivo y una sensibilidad de 0,94 con una especificidad de 0,89 en el punto de corte de ≤ 36/50 para identificar a sujetos con demencia. Conclusiones: El TYM es una prueba cognitiva global autoadministrada, que posee excelentes propiedades psicométricas y buena validez predictiva. Puede usarse como un test cognitivo de cribado en sujetos con 4 o más años de instrucción formal

Objective: To validate a Spanish version of the TYM, a self-administered cognitive screening test designed for the detection of Alzheimer's disease and mild cognitive defect. Methods: A cross-sectional study was conducted in a neurology outpatient clinic. The TYM was administered to individuals of 50 years o more who came to the clinic for whatever the symptom. Their cognitive state was evaluated regardless of the outcome of TYM. They were categorized into 3 groups: 1) Cognitively normal (739), 2) with mild cognitive impairment (183), 3) with dementia (127). An analysis of items was made and the psychometric properties of the TYM were defined. There was a cross-validation, and the predictive validity of the TYM score, adjusted to the demographic variables, was determined by evaluating their performance in ROC curves. Results: The internal consistency, interobserver reliability, short term and long-term test-retest reliability were adequate. The TYM correlated with the MMSE (r = 0.779, P < .0001). The cross validation showed consistent results. With the TYM Score adjusted according to the educational level, a sensitivity of 0.86 with a specificity of 0.88 in the cut-off point of ≤ 40/50 was obtained to identify subjects with cognitive impairment, and a sensitivity of 0.94 with a specificity of 0.89 in the cut-off point of ≤ 36/50 to identify subjects with dementia. Conclusions: The TYM is a self-administered global cognitive test, possessing excellent psychometric properties and good predictive validity. It can be used as a cognitive screening test in subjects with 4 years or more of formal education

El Test Your Memory es sensible al cambio cognitivo pero carece de validez prospectiva / Test Your Memory is sensitive to cognitive change but lacks prospective validity

Objetivo: Determinar la validez prospectiva del Test Your Memory (TYM) y su sensibilidad al cambio de estado cognitivo. Tipo de estudio: Longitudinal prospectivo. Métodos: Se siguió a 71 enfermos con síntomas cognitivos subjetivos y 48 con defecto cognitivo leve durante un periodo de tiempo medio de 35,2 ± 15 meses. Los sujetos no tenían demencia ni depresión al comienzo del seguimiento y a todos se le administró al menos dos veces el TYM. Se aplicó un criterio psicométrico para determinar la existencia de defecto cognitivo (≤ 1,5 puntos z en al menos un dominio cognitivo) y la escala Disability Assessment for Dementia para asegurar la indemnidad funcional. El criterio de empeoramiento fue el cambio de estadio en la Escala de Deterioro Global. Resultados: Sesenta y un enfermos se mantuvieron cognitivamente estables y 58 empeoraron. No hubo diferencia entre ambos grupos con respecto al sexo, el nivel de instrucción, el estadio inicial de la GDS o la puntuación en el primer TYM. Los sujetos que empeoraron tenían más edad. El TYM aumentó un promedio de 0,04 puntos por mes en los pacientes estables o que mejoraron (IC95% -0,01 a 0,08) y disminuyó una media de 0,14 puntos por mes en los que empeoraron (IC95% -0,19 a -0,09). De los sujetos que empeoraron, en los que tenían defecto cognitivo leve la disminución de la puntuación del TYM fue más abrupta que en aquellos con síntomas cognitivos subjetivos. Conclusiones: EL TYM carece de validez prospectiva pero es sensible al cambio de estado cognitivo

Objective: To determine the prospective validity of Test Your Memory (TYM) and its sensitivity to change in cognitive state. Methods: This longitudinal prospective study followed 71 patients with subjective cognitive symptoms and 48 with mild cognitive impairment for a mean time period of 35.2 ± 15 months. Subjects did not have dementia or depression at the beginning of follow-up and each participant was given the TYM at least two times. A psychometric threshold was established to determine presence of a cognitive deficit (z-score ≤ 1.5 on at least one cognitive domain) and the Disability Assessment for Dementia scale was used to ensure full functional ability. The criterion for deterioration was a change in the stage on the Global Deterioration Scale. Results: Sixty-one patients remained cognitively stable and 58 worsened. There were no differences between them with respect to sex, educational attainment, the initial stage on the GDS, or the score on the first TYM. Subjects who worsened were older than those who did not. The TYM increased an average of 0.04 points per month in patients who remained stable or improved (95% CI, -0.01 to 0.08) and decreased an average of 0.14 points per month in those whose condition worsened (95% CI, -0.19 to -0.09). Subjects with mild cognitive impairment who worsened displayed a sharper loss of TYM points than did subjects with subjective cognitive symptoms. Conclusions: While the TYM lacks prospective validity, it is sensitive to changes in cognitive state

Normalización del Test Your Memory y evaluación de su concordancia con los resultados del examen psicométrico / Standardization of the Test Your Memory and evaluation of their concordance with the outcome of the psychometric examination

Objetivo: Explorar la relación entre las puntuaciones del Test Your Memory (TYM) y los hallazgos observados en una valoración neurocognitiva más extensa. Métodos: Se administraron el TYM y 14 pruebas psicométricas a 84 sujetos de 50 o más años que acudieron a una consulta neurológica ambulatoria con sintomatología de estirpe cognitiva. Se determinó su estado cognitivo con independencia del resultado del TYM (CDR 0: 25, CDR 0,5: 45, CDR 1: 14). Se analizaron la validez concurrente del TYM con los hallazgos de la psicometría, así como el grado de concordancia entre ambos tipos de medida, confrontando datos normalizados y tipificados de los instrumentos. Resultados; Aunque el coeficiente de correlación intraclase fue de 0,67 (intervalo de confianza del 95%, 0, 53-0,77), el análisis mediante el gráfico de Bland-Altman y la curva de supervivencia-acuerdo de Luiz et al. demuestran que las distancias individuales entre ambos métodos tienen una dispersión excesiva desde el punto de vista clínico. Los valores predichos por el TYM de la puntuación z media de las pruebas psicométricas discrepan sustancialmente en el 30% de los sujetos y solo aceptando como valores idénticos diferencias absolutas de hasta 0,87 puntos z entre ambas medidas se alcanza un 95% de concordancia. Además, el TYM subestima los rendimientos cognitivos cuando sus valores son bajos y los sobreestima si son elevados. Conclusiones: El TYM es una prueba cognitiva de cribado que no debe utilizarse para predecir el resultado de la psicometría o determinar la ocurrencia de cambio cognitivo en ensayos clínicos

Objective: To explore the relationship between scores on the Test Your Memory (TYM) battery and findings from a more exhaustive neurocognitive assessment. Methods: The TYM and fourteen psychometric tests were administered to 84 subjects aged 50 or older who attended an outpatient neurology clinic due to cognitive symptoms. Each patient's cognitive state was determined independently from his/her score on the TYM (CDR 0, n = 25; CDR 0.5, n = 45; CDR 1, n = 14). We analysed concurrent validity of TYM scores and results from the psychometric tests, as well as the degree of concordance between the two types of measurement, by contrasting normalised data from each instrument. Results: Although the intraclass correlation coefficient was 0.67 (confidence interval 95%, 0.53-0.77), analysis of the Bland-Altman plot and the curve on the survival-agreement plot (Luiz et al. method) demonstrates that the individual distances between the two methods exhibit excessive dispersion from a clinical viewpoint. TYM-based predictions of the mean z-score on psychometric tests differed substantially from real results in 30% of the subjects. Concordance of 95% can only be achieved by accepting absolute inter-instrument differences of up to 0.87 as identical values. Furthermore, the TYM underestimates cognitive performance for low values and overestimates it for high values. Conclusions: The TYM is a cognitive screening test which should not be used to predict results on psychometric tests or to detect cognitive changes in clinical trials

[Five by five test. A brief instrument for the detection of cognitive impediment in clinical settings]. / In process citation.

BACKGROUND AND OBJECTIVE: Many psychological tests for the detection of cognitive impediment and dementia are inadequate by being too prolonged, inconsistent or with poor specificity or sensibility. It is presented a brief test of evocation of proper names by classes (TIG) and their properties psicometrics and utility are compared with the Mini-mental State Examination (MEM). SUBJECTS AND METHODS: We selected 196 patients from a neurological clinic, with suggestive symptoms of cognitive impediment. We excluded individuals with focal or chronic cerebral disorders, sensorial disturbances, severe psychiatric diseases and toxicity by drugs. Patients were by grouped the Clinical Dementia Rating scale and they were evaluated neuropsychologically. The internal consistency of TIG was examined and a cross-validation procedure was performed to test for the predictive validity. Likewise, the convergent validity was tested against the scale of dementia of Blessed and the MEM. Finally the diagnostic efficiency of both tests, the effects of the demographics variables and the clinical utility were analyzed. We used non-parametrics statistics, analysis of sensibility upon curves ROC and analysis of the post-test probabilities. RESULTS: The TIG has adequate internal consistency and validity. The diagnostic efficiency was high (area under the curve ROC 0,939 [IC 95%: 0,908-0,971], p < 0,0001). The introduction of the demographics covariates in a logistic model wisely improved the diagnostic efficiency. The TIG has some better fulfillment than the MEM. Neither the MEM nor the TIG are tests suitable for communitary screening of cognitive defect. CONCLUSIONS: The TIG is briefer, easier to apply and more efficient than the MEM. Possibly it is useful to detect cognitive impediment in clinical contexts. This study is preliminary.

[Prevalence of several neurological diseases in the central provinces of the Iberian Peninsula in eighteen-year-old males]. / Prevalencia de ciertas enfermedades neurológicas en las provincias del centro de la Península Ibérica en los varones de 18 años.

The prevalence of several neurological diseases has been estimated in eighteen-year-old males living in the central provinces of the Iberian Peninsula (Avila, Badajoz, Caceres, Ciudad Real, Cuenca, Guadalajara, Madrid, Toledo and Segovia). To this end, the yearly recruitment census and the neurological evaluations in the recruits form each year between 1985 and 1989 were used. The yearly prevalence rates (per 10,0000) were evaluated for an overall population of 235,976 recruits. Particularly reliable and accurate, among the observed rates, were those related to epilepsy (513), multiple sclerosis (7.6), hereditary ataxias (10.6), neurological form of Wilson's disease (1.7), Tourette's disease (1.3), syringomyelia (0.9), focal neuropathies (74.6), diffuse neuropathies (17.8), myotonic dystrophy (5.5), congenital myotonia (4.7), myasthenia gravis (3.0), hypokalemic periodic paralysis (1.7), and myopathies as a whole (31.8). The possible usefulness to carry out studies with this outlook and the type of conditions more adequate for them are discussed.

El test "cinco por cinco". Un instrumento breve para la detección de impedimento cognitivo en contextos clínicos / "Five by five test". A brief instrument for the detection of cognitive impediment in clinical settings

FUNDAMENTO Y OBJETIVO: Muchos tests psicológicos para la detección de impedimento cognitivo y demencia son inadecuados por ser demasiado largos, inconsistentes o de baja especificidad o sensibilidad. Se presenta un test breve de evocación de nombres propios por clases (TIG) y se comparan sus propiedades psicométricas y utilidad con el Miniexamen Mental (MEM). SUJETOS Y MÉTODOS: Se seleccionó a 196 pacientes que acudieron a una consulta de neurología hospitalaria con quejas indicativas de deterioro mnesicocognitivo y en los que se descartaron afecciones cerebrales focales o crónicas, trastornos sensoriales, alteraciones psiquiátricas graves y toxicidad por fármacos o drogas. Se agrupó a los pacientes por estadio de la escala Clinical Dementia Rating y se les evaluó neuropsicológicamente. Se examinó la consistencia interna del TIG y se efectuó una validación cruzada para probar la validez predictiva. Asimismo, se probó la validez convergente con la escala de demencias de Blessed y el MEM. Por último, se analizó la eficiencia diagnóstica de ambas pruebas, los efectos de las variables demográficas y la utilidad clínica. Se utilizaron pruebas estadísticas no paramétricas, análisis de sensibilidad sobre curvas de características operativas para el receptor (ROC) y análisis de las probabilidades postest. RESULTADOS: El TIG tiene una consistencia interna y una validez adecuada. Se evaluó la eficiencia diagnóstica (área bajo la curva ROC 0,939 [intervalo de confianza (IC) del 95 por ciento: 0,908-0,971]; p < 0,0001).La introducción de las covariables demográficas en un modelo logístico mejoró discretamente la eficiencia diagnóstica. El TIG tiene un desempeño algo mejor que el MEM. Ni el MEM ni el TIG son pruebas idóneas para el cribado de defecto cognitivo en poblaciones. CONCLUSIONES: El TIG es más breve, fácil de aplicar y eficiente que el MEM. Posiblemente, es útil para detectar defectos mnesicocognitivos en contextos clínicos, aunque este estudio es preliminar (AU)