- Email: [email protected]
Systematic review and meta-analysis of the accuracy of the eurotest for the detection of dementia
Poster Presentations P4 and abnormal function. Consistent with this hypothesis, assessment of 9-10 month old mice revealed a further decline in LTP magnitudes (WT: 171.967.7%, n¼7; Het: 136.766.2%, n¼8). Behavioral studies were conducted in parallel to ascertain whether these synaptic deficits correlated with age-related cognitive impairments measured in the Morris water maze, a hippocampal-dependent cognitive assay. Surprisingly, no difference between WT and Het animals was found at any age in MWM performance. Conclusions: These results suggest that overexpression of normal tau protein negatively influences hippocampal synaptic properties, but retain sufficient capacity for performing a hippocampal-dependent behavioral test.
P4-053
SYSTEMATIC REVIEW AND META-ANALYSIS OF THE ACCURACY OF THE EUROTEST FOR THE DETECTION OF DEMENTIA
Beatriz Espejo-Martinez1, Cristo´bal Carnero-Pardo2,1, M. Teresa Montoro-Rı´os2, 1Hospital Universitario Virgen de las Nieves, Granada, Spain; 2FIDYAN Neurocenter, Granada, Spain. Contact e-mail: [email protected] Background: The Eurotest is a short cognitive test applicable to illiterate individuals that is not influenced by the educational level of subjects and can be used throughout the European Union. We carried out a systematic review and performed meta-analyses to determine its usefulness for the diagnosis of dementia. Methods: We included studies that addressed the diagnostic utility of the test, evaluating their methodological quality and performing a meta-analysis of diagnostic parameters (Sensitivity and Specificity) using the MetaDisc programme and a meta-analysis of individual data. Results: Out of a total of ten studies found, six were included with a combined study population of 1569 individuals, of whom 1508 were valid for the individual meta-analysis (316 with dementia, 1192 without dementia).The studies were homogeneous and results were similar between the meta-analyses, showing a higher Sensitivity (0.91 [0.880.94]) than Specificity (0.84 [0.82-0.86]) for a cut-off point of 20/21 that maximises the sum of both parameters, and an area under the ROC curve of 0.945 (0.932-0.956). The meta-analysis yielded precise data on the diagnostic parameters for the different possible cut-off points and on result-specific likelihood ratios.Conclusions: The Eurotest has adequate diagnostic validity to be used as an instrument to screen for and rule out dementia; its negative results are more useful, allowing the presence of dementia to be ruled out with greater certainty.
P4-054
P447
THE ALZHEIMER’S DISEASE CAREGIVER QUESTIONNAIRE (ADCQ): INITIAL VALIDATION OF AN INFORMANT-COMPLETED SCREENING INSTRUMENT FOR MILD COGNITIVE IMPAIRMENT (MCI)
Cynthia A. Murphy1, Paul R. Solomon1,2, 1The Memory Clinic, Bennington, VT, USA; 2Williams College, Williamstown, MA, USA. Contact e-mail: [email protected] Background: Although there are now multiple screening instruments for Alzheimer’s disease that are both sensitive and specific, there are relatively few validated instruments to screen for Mild Cognitive Impairment (MCI). The Alzheimer’s Disease Caregiver Questionnaire (ADCQ)has previously been shown to have high sensitivity and specificity for AD. The purpose of the present study was to provide initial validation of the ADCQ in patients with MCI. Methods: The ADCQ (an 18 item YES/ NO questionnaire) was completed by two groups of people. The first group was comprised of the knowledgeable informants (family member, companion or friend who had regular contact with the patient) of 45 successive referrals to the Memory Clinic in Bennington, VT who were subsequently diagnosed with MCI, while the second group consisted of the knowledgeable informants of 36 cognitively intact, community dwelling volunteers. MCI patients underwent a full diagnostic evaluation including history and physical, neurological evaluation, laboratory evaluation, imaging study, and neuropsychological testing. Patients diagnosed with MCI met the Peterson criteria. Control subjects provided medical/psychological history and underwent neuropsychological testing. Results: Classification and Regression Tree (CART) analysis to determine the sensitivity and specificity of the ADCQ in MCI yielded a sensitivity ¼ 82.2% and a specificity ¼ 88.9%. Other statistical techniques yielded similar accuracy. Conclusions: The results suggest that the ADCQ is sensitive and specific to MCI and may be useful in making the initial distinctions (i.e., screening) between patients experiencing cognitive changes related to the normal aging process and those experiencing cognitive impairments due to MCI. P4-055
DETECTION VALIDITY OF THE DIGIT SPAN AND THE WORD SPAN FOR DEMENTIA
Renata Kochhann, Juliana Varela, Letı´cia Forster, Diego Onyszko, Simone Assis, Ma´rcia Lorena Chaves, Hospital de Clı´nicas de Porto Alegre, Porto Alegre, Brazil. Contact e-mail: [email protected] Background: The aim of this study was to establish the cutoff value for the detection of dementia in the Digit Span (DS) and the Word Span (WS) and compare which of these evaluations is better for the detection of dementia. Methods: The Digit Span and the Word Span, were applied to 97 dementia patients (DSM-IV criteria, Alzheimer’s disease and Vascular dementia) and to 68 healthy elderly subjects. Exclusion criteria include medical and psychiatric conditions, uncorrectable vision or hearing loss; or other conditions such as substance abuse or use of medications that might impair cognitive functioning. The patients were from Dementia Clinic from Hospital de Clı´nicas de Porto Alegre, Brazil. Chi-square was used to analyze categorical variables and Student’s t test for parametric variables. The ROC curve was used to establish cutoffs. Sensitivity, specificity, positive predictive value and negative predictive value were evaluated. Results: The dementia sample and the healthy participants were composed of 51 and 46 females, respectively (p ¼ 0.053). The mean dementia age was 72.367.5, and 68.466.9 on the healthy group (p ¼ 0.001). The mean Digit Span score was 3.762.2 among dementia patients and 5.962.4 among healthy participants (p <001). The mean Word Span score was 2.761.8 among dementia patients and 5.761.5 among healthy participants (p <001). The best cutoff for both tests was five. This cutoff presented 71% and 82% sensitivity for Digit Span and Word Span, and 62% and 81% specificity. The predictive values were: positive 73% and 86% for DS and WS, and negative 60% and 76%. The areas under the curves were 0.75 and 0.88 for DS and WS. Conclusions: The cutoff five for the Digit Span and the Word Span showed good detection values. Nevertheless, the Word Span showed better detection performance than the Digit
P4-053
SYSTEMATIC REVIEW AND META-ANALYSIS OF THE ACCURACY OF THE EUROTEST FOR THE DETECTION OF DEMENTIA
Beatriz Espejo-Martinez1, Cristo´bal Carnero-Pardo2,1, M. Teresa Montoro-Rı´os2, 1Hospital Universitario Virgen de las Nieves, Granada, Spain; 2FIDYAN Neurocenter, Granada, Spain. Contact e-mail: [email protected] Background: The Eurotest is a short cognitive test applicable to illiterate individuals that is not influenced by the educational level of subjects and can be used throughout the European Union. We carried out a systematic review and performed meta-analyses to determine its usefulness for the diagnosis of dementia. Methods: We included studies that addressed the diagnostic utility of the test, evaluating their methodological quality and performing a meta-analysis of diagnostic parameters (Sensitivity and Specificity) using the MetaDisc programme and a meta-analysis of individual data. Results: Out of a total of ten studies found, six were included with a combined study population of 1569 individuals, of whom 1508 were valid for the individual meta-analysis (316 with dementia, 1192 without dementia).The studies were homogeneous and results were similar between the meta-analyses, showing a higher Sensitivity (0.91 [0.880.94]) than Specificity (0.84 [0.82-0.86]) for a cut-off point of 20/21 that maximises the sum of both parameters, and an area under the ROC curve of 0.945 (0.932-0.956). The meta-analysis yielded precise data on the diagnostic parameters for the different possible cut-off points and on result-specific likelihood ratios.Conclusions: The Eurotest has adequate diagnostic validity to be used as an instrument to screen for and rule out dementia; its negative results are more useful, allowing the presence of dementia to be ruled out with greater certainty.
P4-054
P447
THE ALZHEIMER’S DISEASE CAREGIVER QUESTIONNAIRE (ADCQ): INITIAL VALIDATION OF AN INFORMANT-COMPLETED SCREENING INSTRUMENT FOR MILD COGNITIVE IMPAIRMENT (MCI)
Cynthia A. Murphy1, Paul R. Solomon1,2, 1The Memory Clinic, Bennington, VT, USA; 2Williams College, Williamstown, MA, USA. Contact e-mail: [email protected] Background: Although there are now multiple screening instruments for Alzheimer’s disease that are both sensitive and specific, there are relatively few validated instruments to screen for Mild Cognitive Impairment (MCI). The Alzheimer’s Disease Caregiver Questionnaire (ADCQ)has previously been shown to have high sensitivity and specificity for AD. The purpose of the present study was to provide initial validation of the ADCQ in patients with MCI. Methods: The ADCQ (an 18 item YES/ NO questionnaire) was completed by two groups of people. The first group was comprised of the knowledgeable informants (family member, companion or friend who had regular contact with the patient) of 45 successive referrals to the Memory Clinic in Bennington, VT who were subsequently diagnosed with MCI, while the second group consisted of the knowledgeable informants of 36 cognitively intact, community dwelling volunteers. MCI patients underwent a full diagnostic evaluation including history and physical, neurological evaluation, laboratory evaluation, imaging study, and neuropsychological testing. Patients diagnosed with MCI met the Peterson criteria. Control subjects provided medical/psychological history and underwent neuropsychological testing. Results: Classification and Regression Tree (CART) analysis to determine the sensitivity and specificity of the ADCQ in MCI yielded a sensitivity ¼ 82.2% and a specificity ¼ 88.9%. Other statistical techniques yielded similar accuracy. Conclusions: The results suggest that the ADCQ is sensitive and specific to MCI and may be useful in making the initial distinctions (i.e., screening) between patients experiencing cognitive changes related to the normal aging process and those experiencing cognitive impairments due to MCI. P4-055
DETECTION VALIDITY OF THE DIGIT SPAN AND THE WORD SPAN FOR DEMENTIA
Renata Kochhann, Juliana Varela, Letı´cia Forster, Diego Onyszko, Simone Assis, Ma´rcia Lorena Chaves, Hospital de Clı´nicas de Porto Alegre, Porto Alegre, Brazil. Contact e-mail: [email protected] Background: The aim of this study was to establish the cutoff value for the detection of dementia in the Digit Span (DS) and the Word Span (WS) and compare which of these evaluations is better for the detection of dementia. Methods: The Digit Span and the Word Span, were applied to 97 dementia patients (DSM-IV criteria, Alzheimer’s disease and Vascular dementia) and to 68 healthy elderly subjects. Exclusion criteria include medical and psychiatric conditions, uncorrectable vision or hearing loss; or other conditions such as substance abuse or use of medications that might impair cognitive functioning. The patients were from Dementia Clinic from Hospital de Clı´nicas de Porto Alegre, Brazil. Chi-square was used to analyze categorical variables and Student’s t test for parametric variables. The ROC curve was used to establish cutoffs. Sensitivity, specificity, positive predictive value and negative predictive value were evaluated. Results: The dementia sample and the healthy participants were composed of 51 and 46 females, respectively (p ¼ 0.053). The mean dementia age was 72.367.5, and 68.466.9 on the healthy group (p ¼ 0.001). The mean Digit Span score was 3.762.2 among dementia patients and 5.962.4 among healthy participants (p <001). The mean Word Span score was 2.761.8 among dementia patients and 5.761.5 among healthy participants (p <001). The best cutoff for both tests was five. This cutoff presented 71% and 82% sensitivity for Digit Span and Word Span, and 62% and 81% specificity. The predictive values were: positive 73% and 86% for DS and WS, and negative 60% and 76%. The areas under the curves were 0.75 and 0.88 for DS and WS. Conclusions: The cutoff five for the Digit Span and the Word Span showed good detection values. Nevertheless, the Word Span showed better detection performance than the Digit