Effectiveness and costs of phototest in dementia and cognitive impairment screening

<p>Abstract</p> <p>Background</p> <p>To assess and compare the effectiveness and costs of Phototest, Mini Mental State Examination (MMSE), and Memory Impairment Screen (MIS) to screen for dementia (DEM) and cognitive impairment (CI).</p> <p>Methods</p> <p>A phase III study was conducted over one year in consecutive patients with suspicion of CI or DEM at four Primary Care (PC) centers. After undergoing all screening tests at the PC center, participants were extensively evaluated by researchers blinded to screening test results in a Cognitive-Behavioral Neurology Unit (CBNU). The gold standard diagnosis was established by consensus of expert neurologists. Effectiveness was assessed by the proportion of correct diagnoses (diagnostic accuracy [DA]) and by the kappa index of concordance between test results and gold standard diagnoses. Costs were based on public prices and hospital accounts.</p> <p>Results</p> <p>The study included 140 subjects (48 with DEM, 37 with CI without DEM, and 55 without CI). The MIS could not be applied to 23 illiterate subjects (16.4%). For DEM, the maximum effectiveness of the MMSE was obtained with different cutoff points as a function of educational level [k = 0.31 (95% Confidence interval [95%CI], 0.19-0.43), DA = 0.60 (95%CI, 0.52-0.68)], and that of the MIS with a cutoff of 3/4 [k = 0.63 (95%CI, 0.48-0.78), DA = 0.83 (95%CI, 0.80-0.92)]. Effectiveness of the Phototest [k = 0.71 (95%CI, 0.59-0.83), DA = 0.87 (95%CI, 0.80-0.92)] was similar to that of the MIS and higher than that of the MMSE. Costs were higher with MMSE (275.9 ± 193.3€ [mean ± sd euros]) than with Phototest (208.2 ± 196.8€) or MIS (201.3 ± 193.4€), whose costs did not significantly differ. For CI, the effectiveness did not significantly differ between MIS [k = 0.59 (95%CI, 0.45-0.74), DA = 0.79 (95%CI, 0.64-0.97)] and Phototest [k = 0.58 (95%CI, 0.45-0.74), DA = 0.78 (95%CI, 0.64-0.95)] and was lowest for the MMSE [k = 0.27 (95%CI, 0.09-0.45), DA = 0.69 (95%CI, 0.56-0.84)]. Costs were higher for MMSE (393.4 ± 121.8€) than for Phototest (287.0 ± 197.4€) or MIS (300.1 ± 165.6€), whose costs did not significantly differ.</p> <p>Conclusion</p> <p>MMSE is not an effective instrument in our setting. For both DEM and CI, the Phototest and MIS are more effective and less costly, with no difference between them. However, MIS could not be applied to the appreciable percentage of our population who were illiterate.</p

The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol

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Incidence and clinical impact of infective endocarditis after transcatheter aortic valve implantation

Aims: To describe the characteristics of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). Methods and results: This study was performed using the GAMES database, a national prospective registry of consecutive patients with IE in 26 Spanish hospitals. Of the 739 cases of IE diagnosed during the study, 1.3% were post-TAVI IE, and these 10 cases, contributed by five centres, represented 1.1% of the 952 TAVIs performed. Mean age was 80 years. All valves were implanted transfemorally. IE appeared a median of 139 days after implantation. The mean age-adjusted Charlson comorbidity index was 5.45. Chronic kidney disease was frequent (five patients), as were atrial fibrillation (five patients), chronic obstructive pulmonary disease (four patients), and ischaemic heart disease (four patients). Six patients presented aortic valve involvement, and four only mitral valve involvement; the latter group had a higher percentage of prosthetic mitral valves (0% vs. 50%). Vegetations were found in seven cases, and four presented embolism. One patient underwent surgery. Five patients died during follow-up: two of these patients died during the admission in which the valve was implanted. Conclusions: IE is a rare but severe complication after TAVI which affects about 1% of patients and entails a relatively high mortality rate. IE occurred during the first year in nine of the 10 patients

Estudio FOTOTRANS: estudio multicéntrico sobre la validez del Fototest en condiciones de práctica clínica

Resumen: Objetivo: El Fototest es un test breve, fácil, aplicable a analfabetos y no influido por el nivel educativo. El objetivo de este estudio es evaluar su validez para deterioro cognitivo (DC) y demencia (DEM) en condiciones de práctica clínica habitual. Material y métodos: Estudio transversal multicéntrico y naturalístico realizado en consultas de neurología general. Se incluyó a sujetos mayores de 60 años con diagnóstico previamente establecido de no deterioro cognitivo (NoDC), deterioro cognitivo sin demencia (DCsD) o demencia (DEM). La validez discriminativa se evaluó mediante el área bajo la curva ROC (aROC), sensibilidad (S), especificidad (E) y cocientes de probabilidad. Se calcularon correlaciones parciales ajustadas por edad, sexo y nivel educativo con Eurotest, fluidez verbal semántica (FVS) y el estadio GDS para evaluar la validez concurrente y de constructo. Resultados: Diecinueve neurólogos incluyeron a un total de 589 sujetos: 361 NoDC, 106 DCsD y 122 DEM. La validez discriminativa es mejor para DEM (aROC 0,94 ± 0,02) que para DC (0,86 ± 0,02). Para DEM el mejor punto de corte es 26/27 (S = 0,88 [IC del 95%, 0,93-0,97], E = 0,87 [IC del 95%, 0,84-0,90]), y para DC, 28/29 (S = 0,71 [IC del 95%, 0,65-0,77], E = 0,84 [IC del 95%, 0,80-0,88]). El Fototest muestra una alta y significativa correlación con el Eurotest (r = 0,70 ± 0,02), la FVS (r = 0,68 ± 0,02) y el estadio GDS (r = –0,77 ± 0,02). Conclusión: El Fototest muestra una adecuada validez para DC y DEM, en consultas generales de neurología de un extenso y variado ámbito geográfico. Abstract: Objective: Fototest is a short simple test, applicable to illiterate subjects and not influenced by educational level. The purpose of this study is to assess its validity for cognitive impairment (CI) and dementia (DEM) under routine clinical practice conditions. Material and methods: A cross-sectional, multicentre and naturalistic study conducted in General Neurology clinics. The subjects were, over 60 years old, with a previously established diagnosis of no cognitive impairment (NoCI), cognitive impairment without dementia (CInoDEM), or dementia (DEM). The discriminant validity was assessed using the area under the ROC curve (AUC), sensitivity (Sn), specificity (Sp), and probability coefficients. Partial correlations were calculated, adjusted for age, sex and education level with Eurotest, verbal fluency test (VFT) and Global Deterioration Scale (GDS) score to evaluate the concurrent and construct validity. Results: Nineteen neurologists included a total of 589 subjects: 361 NoCI, 106 CINoDEM and 122 DEM. The discriminant value was better for DEM (AUC 0.94 ± 0.02) than for CI (0.86 ± 0.02). For DEM the best cut-off point was 26/27 (Sn = 0.88 [95% CI, 0.93-0.97], Sp = 0.87 [95% CI, 0.84-0.90]); and for CI, 28/29 (Sn = 0.71 [95% CI, 0.65-0.77], Sp = 0.84 [95% CI, 0.80-0.88]). Fototest showed a high and significant correlation with Eurotest (r = 0.70 ± 0.02), VFT (r = 0.68 ± 0.02) and the GDS score (r = -0.77 ± 0.02). Conclusion: The Fototest showed adequate validity for CI and DEM in general Neurology clinics in an extensive and wide geographical area. Palabras clave: Test de cribado, Test cognitivo breve, Fototest, Deterioro cognitivo, Demencia, Keywords: Screening test, Short cognitive test, Fototest, Cognitive impairment, Dementi

FOTOTRANS Study. Multicentre study on the validity of Fototest under clinical practice conditions

Objective: Fototest is a short simple test, applicable to illiterate subjects and not influenced by educational level. The purpose of this study is to assess its validity for cognitive impairment (CI) and dementia (DEM) under routine clinical practice conditions. Material and methods: A cross-sectional, multicentre and naturalistic study conducted in General Neurology clinics. The subjects were over 60 years old, with a previously established diagnosis of no cognitive impairment (NoCI), cognitive impairment without dementia (CInoDEM), or dementia (DEM). The discriminant validity was assessed using the area under the ROC curve (AUC), sensitivity (Sn), specificity (Sp), and probability coefficients. Partial correlations were calculated, adjusted for age, sex and education level with Eurotest, verbal fluency test (VFT) and Global Deterioration Scale (GDS) score to evaluate the concurrent and construct validity. Results: Nineteen neurologists included a total of 589 subjects: 361 NoCI, 106 CINoDEM and 122 DEM. The discriminant value was better for DEM (AUC 0.94 ± 0.02) than for CI (0.86 ± 0.02). For DEM the best cut-off point was 26/27 (Sn = 0.88 [95% CI, 0.93-0.97], Sp = 0.87 [95% CI, 0.84–0.90]); and for CI, 28/29 (Sn = 0.71 [95% CI, 0.65–0.77], Sp = 0.84 [95% CI, 0.80–0.88]). Fototest showed a high and significant correlation with Eurotest (r = 0.70 ± 0.02), VFT (r = 0.68 ± 0.02) and the GDS score (r = −0.77 ± 0.02). Conclusion: The Fototest showed adequate validity for CI and DEM in general neurology clinics in an extensive and wide geographical area. Resumen: Objetivo: El Fototest es un test breve, fácil, aplicable a analfabetos y no influido por el nivel educativo. El objetivo de este estudio es evaluar su validez para deterioro cognitivo (DC) y demencia (DEM) en condiciones de práctica clínica habitual. Material y métodos: Estudio transversal multicéntrico y naturalístico realizado en consultas de neurología general. Se incluyó a sujetos mayores de 60 años con diagnóstico previamente establecido de no deterioro cognitivo (NoDC), deterioro cognitivo sin demencia (DCsD) o demencia (DEM). La validez discriminativa se evaluó mediante el área bajo la curva ROC (aROC), sensibilidad (S), especificidad (E) y cocientes de probabilidad. Se calcularon correlaciones parciales ajustadas por edad, sexo y nivel educativo con Eurotest, fluidez verbal semántica (FVS) y el estadio GDS para evaluar la validez concurrente y de constructo. Resultados: Diecinueve neurólogos incluyeron a un total de 589 sujetos: 361 NoDC, 106 DCsD y 122 DEM. La validez discriminativa es mejor para DEM (aROC 0,94 ± 0,02) que para DC (0,86 ± 0,02). Para DEM el mejor punto de corte es 26/27 (S = 0,88 [IC del 95%, 0,93-0,97], E = 0,87 [IC del 95%, 0,84-0,90]), y para DC, 28/29 (S = 0,71 [IC del 95%, 0,65-0,77], E = 0,84 [IC del 95%, 0,80-0,88]). El Fototest muestra una alta y significativa correlación con el Eurotest (r = 0,70 ± 0,02), la FVS (r = 0,68 ± 0,02) y el estadio GDS (r = –0,77 ± 0,02). Conclusión: El Fototest muestra una adecuada validez para DC y DEM, en consultas generales de neurología de un extenso y variado ámbito geográfico. Keywords: Screening test, Short cognitive test, Fototest, Cognitive impairment, Dementia, Palabras clave: Test de cribado, Test cognitivo breve, Fototest, Deterioro cognitivo, Demenci