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Introducción. El objetivo es estudiar la validez de criterio de la Alzheimer's Disease Assessment Scale (ADAS) y de su subescala cognitiva ADAS-Cog para el diagnóstico de la enfermedad de Alzheimer (EA) y determinar diferentes puntos de corte obteniendo la sensibilidad y especificidad diagnósticas respectivas. Además se pretenden estudiar las correlaciones de las puntuaciones de la escala ADAS con medidas funcionales.Métodos. Se estudiaron 451 sujetos (254 controles sanos,86 casos con deterioro cognitivo sin demencia y 111 sujetos afectos de EA). Se obtuvieron las puntuaciones de la escala ADAS-total. La puntuación global es la resultante de la suma de dos subtests: la subescala cognitiva (ADAS-Cog) y la subescala no cognitiva (ADAS-Nocog). Se aplicaron ajustes por edad y escolaridad correspondientes para cada sujeto. A fin de poder establecer la correlación con medidas funcionalesse administraron la Rapid Disability Rating Scale-2(RDRS-2), la Blessed Dementia Rating Scale (BDRS) y la escala Interview for Detererioration of Daily Living in Dementia (IDDD). El estudio estadístico se realizó mediante las curvas ROC y el coeficiente de correlación de Pearson. Resultados. El punto de corte más equilibrado para la ADAS-total ajustado por edad y escolaridad fue de >= 17 (sensibilidad: 90,09 %, y especificidad: 85,88%). El punto de corte más equilibrado del ADAS-Cog ajustado por edad y escolaridad fue de >= 12 (sensibilidad: 89,19 %, y especificidad: 88,53%). El área bajo la curva ROC fue, respectivamente, 0,95 y 0,94. La escala ADAS-total y ADAS-Cog presentan buenas correlaciones con las escalas funcionales estudiadas. Conclusiones. Tanto la ADAS-total como la ADAS-Cog presentan una buena validez discriminativa en términos de sensibilidad, especificidad y valor predictivo. Asimismo existe una buena correlación entre el deterioro funcional estudiado en los pacientes con EA y la puntuación obtenida en ambas escalas

Introduction. The aims of this study were to assessthe criterion validity of Alzheimer's Disease AssessmentScale (ADAS) and its cognitive subscale (ADAS-Cog) forthe diagnosis of Alzheimer’s disease (AD), and to determine their different cut-off scores and sensitivity and specificity values. In addition, we also attempted tostudy the possible correlations between cognitive scores(ADAS) and functional measures. Methods. 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with AD). ADAS total score was obtained by adding the cognitive (ADAS-Cog) and non-cognitive (ADAS-Nocog) scales. Scores were adjusted for age and formal education. For assessing the possible correlation between cognitive and functional measures, the following instruments were administered: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS) and the Interview for the Deterioration of Daily Living in Dementia (IDDD). Statistical analysis: ROC curves and Pearson correlation coefficient. Results. ADAS best cut-off score for dementia was >=17 providing sensitivity and specificity values of 90.09% and 85.88 % respectively, while for the ADAS-Cog best cut-off score was >= 12 with sensitivity and specificity values of 89.19 % and 88.53 % respectively. In both cases scores were adjusted for age and formal education. The area under the ROC curve was 0.95 and 0.94 respectively. Highly significant correlations were found for ADAS and 19 ADAS-Cog with the functional scales studied. Conclusions. Both, ADAS and ADAS-Cog report good validity in terms of sensitivity, specificity and as predictive value for AD. Moreover, significant correlations were found between the functional impairment observed in patients with AD and the overall scores achieved in the ADAS and ADAS-Cog

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INTRODUCTION: The aims of this study were to assess the criterion validity of Alzheimer's Disease Assessment Scale (ADAS) and its cognitive subscale (ADAS-Cog) for the diagnosis of Alzheimer's disease (AD), and to determine their different cut-off scores and sensitivity and specificity values. In addition, we also attempted to study the possible correlations between cognitive scores (ADAS) and functional measures. METHODS: 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with AD). ADAS total score was obtained by adding the cognitive (ADAS-Cog) and non-cognitive (ADAS-Nocog) scales. Scores were adjusted for age and formal education. For assessing the possible correlation between cognitive and functional measures, the following instruments were administered: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS) and the Interview for the Deterioration of Daily Living in Dementia (IDDD). STATISTICAL ANALYSIS: ROC curves and Pearson correlation coefficient. RESULTS: ADAS best cut-off score for dementia was > or = 17 providing sensitivity and specificity values of 90.09% and 85.88 % respectively, while for the ADAS-Cog best cut-off score was > or = 12 with sensitivity and specificity values of 89.19 % and 88.53 % respectively. In both cases scores were adjusted for age and formal education. The area under the ROC curve was 0.95 and 0.94 respectively. Highly significant correlations were found for ADAS and 19 ADAS-Cog with the functional scales studied. CONCLUSIONS: Both, ADAS and ADAS-Cog report good validity in terms of sensitivity, specificity and as predictive value for AD. Moreover, significant correlations were found between the functional impairment observed in patients with AD and the overall scores achieved in the ADAS and ADAS-Cog.

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El diagnóstico preciso de las demencias, así como el cribado de los trastornos cognitivos, es una clave para atender las necesidades de la realidad sociodemográfica. En este artículo se plantean los objetivos del cribado y del diagnóstico, los instrumentos que se utilizan y sus características psicométricas esenciales, especialmente la fiabilidad y la validez. Se destaca la necesidad de evaluar críticamente las publicaciones sobre el tema y se refieren los Standards for Reporting of Diagnostic Accuracy (STARD). Además se citan y revisan propuestas y recomendaciones de la literatura. Por último se comentan los tests más estudiados y usados por neurólogos españoles. Destacan el MMSE (Mini-Mental State Examination), el MIS (Memory Impairmet Screen) y el Eurotest

The accurate diagnosis of dementias and the screening of cognitive impairment constitute a key to attend to the sociodemographical needs. This paper states the aims of screening and diagnosis, the tools used and their main psychometric features, especially, reliability and validity. The need to critically review the publications on this subject is highlighted and the Standards for Reporting of Diagnostic Accuracy (STARD) are mentioned. In addition, some proposals and recommendations from literature are cited and reviewed. Finally, the tests studied and used most by Spanish neurologists are commented on. The MMSE (Mini-Mental Status Examination), the MIS (Memory Impairment Screen) and the Eurotest stand out

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The accurate diagnosis of dementias and the screening of cognitive impairment constitute a key to attend to the sociodemographical needs. This paper states the aims of screening and diagnosis, the tools used and their main psychometric features, especially, reliability and validity. The need to critically review the publications on this subject is highlighted and the Standards for Reporting of Diagnostic Accuracy (STARD) are mentioned. In addition, some proposals and recommendations from literature are cited and reviewed. Finally, the tests studied and used most by Spanish neurologists are commented on. The MMSE (Mini-Mental Status Examination), the MIS (Memory Impairment Screen) and the Eurotest stand out.

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Introducción. El propósito del presente artículo fue el estudio de la Rapid Disability Rating Scale-2 (RDRS-2) en la enfermedad de Alzheimer (EA). Se analiza la fiabilidad testretest, la consistencia interna, la validez discriminativa de esta escala y el grado de correlación con otras escalas funcionales y cognitivas. Material y métodos. Se estudiaron 451 sujetos: 254 controles sanos, 86 casos de deterioro cognitivo sin demencia (DSD) y 111 sujetos afectos de EA. Se obtuvieron las puntuaciones de los diversos apartados de la escala de RDRS-2. La puntuación total de la RDRS-2 es la suma resultante de tres subescalas: actividades de la vida diaria, grado de discapacidad y problemas especiales. A fin de poder establecer su correlación con otras escalas funcionales y tests cognitivos se aplicaron la Blessed Dementia Rating Scale (BDRS), Interview for Detererioration of Daily Living in Dementia (IDDD), la subescala cognitiva del Alzheimer's Disease Assessment Scale (ADASCog) y el Mini-Mental State Examination (MMSE). Estudio estadístico: regresión lineal multivariable. Validación cruzada. Curvas ROC. Coeficiente de correlación intraclase. Coeficiente alfa de Cronbach. Coeficiente de Pearson. Resultados. Las puntuaciones obtenidas de la RDRS-2 (media y DE) fueron las siguientes: controles (18,95; 1,64), DSD (20,61; 2,88) y EA (28,96; 9,07). La regresión lineal multivariable demostró que la puntuación de la RDRS-2 no está influenciada por factores socioculturales, tales como la edad o la escolaridad. Se objetivaron las siguientes correlaciones: BDRS, r=0,820; IDDD, r=0,882; ADAS-Cog, r=0,762, y MMSE, r=0,742. El coeficiente de correlación intraclase fue de 0,86 y el coeficiente alfa de Cronbach de 0,91. El punto de corte más equilibrado de la RDRS-2 fue 21 (sensibilidad: 82,88 %, y especificidad: 88,8 %). El área bajo la curva ROC fue de 0,92. Conclusiones. La presente versión en lengua castellana de la RDRS-2 no está influenciada por factores socioculturales, presenta gran fiabilidad test-retest y consistencia interna. Aunque no fue diseñada específicamente para usarla en la EA, se correlaciona de forma significativa con otras escalas funcionales y además existe una buena correlación con el grado de deterioro cognitivo presente en pacientes con EA (AU)

INTRODUCTION: The study aimed to investigate the Rapid Disability Rating Scale-2 (RDRS-2) in Alzheimer's disease (AD). Test retest reliability, internal consistency, data of discriminant validity of the scale, correlations with other functional and cognitive measures were analyzed. MATERIAL AND METHODS: 451 subjects were assessed: 254 healthy controls, 86 with cognitive impairment but no dementia (CIND) and 111 subjects diagnosed of AD. Total and subscales scores of the RDRS-2 were obtained. The total score is the sum of three subscales: activities of daily living, disability, and special problems. To establish its correlation with other functional scales and cognitive instruments, the following tools were applied: Blessed Dementia Rating Scale (BDRS), Interview for the Deterioration of Daily Living in Dementia (IDDD), Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) and the Mini-Mental State Examination (MMSE). STATISTICAL ANALYSIS: lineal multivariate regression analysis. Crossvalidation. ROC curves. Intraclass coefficient. Cronbach's alpha and Pearson's Correlation coefficient. RESULTS: RDRS-2 scores by group were the following (mean and SD): Controls (18.95; 1.64), CIND (20.61; 2.88), and AD (28.96; 9.07). Results from regression analysis 282 demonstrated absence of influence of sociocultural variables such as age and education in RDRS-2 scores. Correlations with other instruments were as following: BDRS, r=0.820; IDDD, r=0.882; ADAS-Cog, r=0.762, and MMSE, r=0.742. Intraclass coefficient was 0.86 and Cronbach's alpha was 0.91. For the RDRS-2 the best cutoff score was 21 (82.88% sensitivity and 88.8% specificity). Area under the ROC curve was 0.92. CONCLUSIONS: The Spanish adaptation of the RDRS-2 is free of sociocultural influence, and shows very adequate data on internal consistency and stability. Although not specifically designed for its use in AD it correlates highly and significantly with other functional scales as well as with the degree of cognitive impairment in AD (AU)

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INTRODUCTION: The study aimed to investigate the Rapid Disability Rating Scale-2 (RDRS-2) in Alzheimer's disease (AD). Test retest reliability, internal consistency, data of discriminant validity of the scale, correlations with other functional and cognitive measures were analyzed. MATERIAL AND METHODS: 451 subjects were assessed: 254 healthy controls, 86 with cognitive impairment but no dementia (CIND) and 111 subjects diagnosed of AD. Total and subscales scores of the RDRS-2 were obtained. The total score is the sum of three subscales: activities of daily living, disability, and special problems. To establish its correlation with other functional scales and cognitive instruments, the following tools were applied: Blessed Dementia Rating Scale (BDRS), Interview for the Deterioration of Daily Living in Dementia (IDDD), Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) and the Mini-Mental State Examination (MMSE). STATISTICAL ANALYSIS: lineal multivariate regression analysis. Crossvalidation. ROC curves. Intraclass coefficient. Cronbach's alpha and Pearson's Correlation coefficient. RESULTS: RDRS-2 scores by group were the following (mean and SD): Controls (18.95; 1.64), CIND (20.61; 2.88), and AD (28.96; 9.07). Results from regression analysis 282 demonstrated absence of influence of sociocultural variables such as age and education in RDRS-2 scores. Correlations with other instruments were as following: BDRS, r=0.820; IDDD, r=0.882; ADAS-Cog, r=0.762, and MMSE, r=0.742. Intraclass coefficient was 0.86 and Cronbach's alpha was 0.91. For the RDRS-2 the best cutoff score was 21 (82.88% sensitivity and 88.8% specificity). Area under the ROC curve was 0.92. CONCLUSIONS: The Spanish adaptation of the RDRS-2 is free of sociocultural influence, and shows very adequate data on internal consistency and stability. Although not specifically designed for its use in AD it correlates highly and significantly with other functional scales as well as with the degree of cognitive impairment in AD.

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INTRODUCTION: This study aims to discover the criterion validity of the Blessed Dementia Rating Scale (BDRS) for the diagnosis of Alzheimer's disease. Different cut-off scores and corresponding diagnostic sensitivities and specificities were established. Test-retest reliability and internal consistency of the BDRS were also analyzed. SAMPLE: 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with Alzheimer's disease). INSTRUMENTS: scores from different sections of the Blessed score were obtained. The global score (BBRS-Total) is the result of the sum of the three sections, A (changes in every day activities), B (changes in habits) and C (changes in personality). The sum of parts A and B (BDRS-Mod) were also quantified. STATISTICS: ROC curves, intraclass correlation coefficient and Cronbach's alpha. RESULTS: The best cut-off score for the BDRS-Total was 3.5 (sensitivity: 87.39%, and specificity: 90%). For the BDRS-Mod, the best cut-off score was 1.5 (sensitivity: 90%, and specificity: 89%). Area under the ROC curve was 0.964 and 0.963 respectively. Intraclass correlation coefficient was 0.98 and Cronbach's alpha was 0.925. CONCLUSIONS: The BDRS has good discriminative validity in terms of sensitivity, specificity and predictive value. It also has good test-retest reliability and internal consistency.

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Introducción. El objetivo es establecer la validez de criterio de la Blessed Dementia Rating Scale (BDRS) para el diagnóstico de la enfermedad de Alzheimer (EA), estableciendo diferentes puntos de corte y obteniendo la sensibilidad y especificidad respectiva. Además se analiza la fiabilidad test-retest y la consistencia interna de la escala. Métodos. Se estudiaron 451 sujetos (254 controles sanos, 86 casos con trastorno cognitivo leve y 111 sujetos afectos de EA). Se obtuvieron las puntuaciones de los diversos apartados de la escala de Blessed. La puntuación global (BDRS-Total) es la suma resultante de los tres apartados: A (cambios en las actividades de la vida diaria), B (cambios en hábitos) y C (cambios en personalidad). Se cuantificó asimismo la puntuación obtenida de la suma resultante de los apartados A y B (BDRS Mod). Estudio estadístico: curvas ROC, coeficiente de correlación intraclase, alfa de Cronbach. Resultados. El punto de corte más equilibrado de la BDRS-Total es 3,5 (sensibilidad: 87,39 %, Y especificidad: 90 %). El punto de corte más equilibrado de la BDRS-Mod es 1,5 (sensibilidad: 90%, y especificidad: 89%). El área bajo la curva ROC es de 0,964 y 0,963, respectivamente. El coeficiente de correlación intraclase fue de 0,98. El coeficiente alfa de Cronbach fue de 0,925. Conclusiones. La BDRS presenta una buena validez discriminativa en términos de sensibilidad, especificidad y valor predictivo, así como adecuada fiabilidad test-retest

Introduction. This study aims to discover the criterion validity of the Blessed Dementia Rating Scale (BDRS) for the diagnosis of Alzheimer's disease. Different cut-off scores and corresponding diagnostic sensitivities and specificities were established. Test-retest reliability and internal consistency of the BDRS were also analyzed. Methods. Sample: 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with Alzheimer's disease). Instruments: scores fram different sections of the Blessed score were obtained. The global score (BBRS- Total) is the result of the sum of the three sections, A (changes in every day activities), B (changes in habits) and C (changes in personality). The sum of parts A and B (BDRS-Mod) were also quantified. Statistics: ROC curves, intraclass correlation coefficient and Cronbach's alpha. Results. The best cut-off score for the BDRS-Total was 3.5 (sensitivity: 87.39 %, and specificity: 90 %). For the BDRS-Mod, the best cut-off score was 1.5 (sensitivity: 90 %, and specificity: 89 %). Area under the ROC curve was 0.964 and 0.963 respectively. Intraclass correlation coefficient was 0.98 and Cronbach's alpha was 0.925. Conclusions. The BDRS has good discriminative validity in terms of sensitivity, specificity and predictive value. It also has good test-retest reliability and internal consistency

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INTRODUCTION: The objective is to establish the existence of possible correlations between cognitive measures using the a-BT, and functional measures in a population of normal to moderately severe demented subjects. METHODS: A sample of 107 subjects (42 healthy controls, 19 subjects with mild cognitive impairment and 46 patients with probable Alzheimer's disease) were included in the present study. The instruments of the cognitive measure used was the abbreviated Barcelona Test (a-BT), a test of general cognitive function. Apart from that, the following functional scales, evaluating activities of daily living, were used: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), and Interview for Deterioration in Daily living in Dementia (IDDD). The statistical procedures were the correlations between cognitive and functional measures using Pearson's correlation coefficient. RESULTS: The correlations obtained between the cognitive and all functional measures were all highly significant (p < 0.0001) and consistently high, with correlations ranging between 0.72 and 0.80. Correlations between the a-BT and functional measures of more basic activities of daily living (RDRS-2, BDRS) were lower than those that included instrumental and some advanced activities of daily living (IDDD). DISCUSSION: The present paper establishes the existence of satisfactory correlations between the functional measures studied and the global scores of the a-BT. These correlations are applicable for groups of subjects with cognitive impairment that does not reach the threshold of a diagnosis of dementia as well as subjects suffering from Alzheimer's disease, at least up to moderately severe cases. The global score of the a-BT allows for some degree of prediction of the functional status of a subject with suspected Alzheimer's disease pathology evaluated.

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Introducción. El objetivo del presente trabajo es establecer el grado de las posibles correlaciones de las puntuaciones globales del Test Barcelona Abreviado (TB-A) con escalas funcionales de la vida diaria. Métodos. Se estudiaron 107 sujetos (42 controles sanos, 19 casos de trastorno cognitivo leve y 46 sujetos afectos de enfermedad de Alzheimer). Se obtuvieron las puntuaciones del Test Barcelona y de las escalas funcionales siguientes: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS) e Interview for Deterioration of Daily Living in Dementia (IDDD). En el estudio estadístico se estableció el grado de correlación mediante el coeficiente de Pearson. Resultados. Todas las correlaciones obtenidas fueron significativas (p < 0,0001) y altas, con una variación desde 0,72 a 0,80. Las puntuaciones estandarizadas del TB-A tienen un rango menor de correlación en relación con las puntuaciones brutas en el caso de la RDRS-2 y la BDRS y superior en caso de la IDDD. Discusión. Este trabajo establece la existencia de una buena correlación funcional de las puntuaciones globales del TB-A y las actividades de la vida diaria, al menos en los casos del deterioro cognitivo propio de los trastornos leves sin demencia y los grados discretos a moderados-graves de la enfermedad de Alzheimer. El TB-A permite predecir el estado funcional de los sujetos

Introduction. The objective is to establish the existence of possible correlations between cognitive measures using the a-BT, and functional measures in a population of normal to moderately severe demented subjects. Methods. A sample of 107 subjects (42 healthy controls, 19 subjects with mild cognitive impairment and 46 patients with probable Alzheimer’s disease) were included in the present study. The instruments of the cognitive measure used was the abbreviated Barcelona Test (a-BT), a test of general cognitive function. Apart from that, the following functional scales, evaluating activities of daily living, were used: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), and Interview for Deterioration in Daily living in Dementia (IDDD). The statistical procedures were the correlations between cognitive and functional measures using Pearson’s correlation coefficient. Results. The correlations obtained between the cognitive and all functional measures were all highly significant (p < 0.0001) and consistently high, with correlations ranging between 0.72 and 0.80. Correlations between the a-BT and functional measures of more basic activities of daily living (RDRS-2, BDRS) were lower than those that included instrumental and some advanced activities of daily living (IDDD). Discussion. The present paper establishes the existence of satisfactory correlations between the functional measures studied and the global scores of the a-BT. These correlations are applicable for groups of subjects with cognitive impairment that does not reach the threshold of a diagnosis of dementia as well as subjects suffering from Alzheimer’s diasease, at least up to moderately severe cases. The global score of the a-BT allows for some degree of prediction of the functional status of a subject with suspected Alzheimer’s diasease pathology evaluated

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We present a case report of invasive hepatic fascioliasis. Ramified hypodense lesions with peripheral distribution were found in the CT-scan. These lesions disappeared after treatment with Bithionol. CT-scan plays an important role in the diagnosis of invasive fascioliasis whereas ultrasound is useful in the chronic phase. Both are helpful to evaluate response to treatment.

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