We assessed the interobserver agreement on the clinical diagnosis of dementia syndrome and dementia subtypes as part of a cross-national project on the prevalence of dementia. Fourteen clinicians from the participating countries (Canada, Chile, Malta, Nigeria, Spain, and the United States) independently assessed the diagnosis of 51 patients whose clinical information was in standard records written in English. We used the DSM-III-R and ICD-10 criteria for dementia syndrome, the NINCDS-ADRDA criteria for Alzheimer's disease (AD), and the ICD-10 criteria for other dementing diseases, and measured interobserver agreement. We found comparable levels of agreement on the diagnosis of dementia using the DSM-III-R (kappa = 0.67) as well as the ICD-10 criteria (kappa = 0.69). Cognitive impairment without dementia was a major source of disagreement (kappa = 0.10). The kappa values were 0.58 for probable AD, 0.12 for possible AD, and rose to 0.72 when the two categories were merged. The interrater reproducibility of the diagnosis of vascular dementia was 0.66 in terms of kappa index; the diagnoses of other dementing disorders as a whole reached a kappa value of 0.40. This study suggests that clinicians from different cultures and medical traditions can use the DSM-III-R and the ICD-10 criteria for dementia effectively and thus reliably identify dementia cases in cross-national research. The interrater agreement on the diagnosis of dementia might be improved if clear-cut guidelines in the definition of cognitive impairment are provided. To improve the reliability of AD diagnosis in epidemiologic studies, we suggest that the NINCDS-ADRDA "probable" and "possible" categories be merged.

Estudio descriptivo relacional, destinado a conocer la autoestima y el funcionamiento social de los ancianos según roles sociales, desde su visión y la de sus cuidadores y la percepción del funcionamiento familiar. Se incluyó a 300 ancianos y sus cuidadores familiares, de los consultorios de atención primaria de Concepción. Se aplicó una encuesta en domicilio, con tres escalas: Groningen Social Disabilities Schedule; Escala de Funcionamiento Familiar de Smilkeinstein y el Test de Autoestima de Rosenberg. Resultados: el 51% de los ancianos reportan una alta autoestima. La percepción de funcionamiento familiar de éstos se ubica en un 84%, lo que corresponde a la más alta categoría de esta variable. No se encontró diferencia estadísticamente significativa en la evaluación de la percepción de funcionamiento social, entre la autoevaluación del anciano y la evaluación que hace el cuidador respecto del anciano. Es importante destacar una alta consistencia entre ambas mediciones, correlación de un 74%. Respecto a la relación entre las mediciones del autorreporte de funcionamiento social de los ancianos y la escala de autoestima, se encontró una correlación positiva, a mejor funcionamiento social obtenido del autorreporte, mayor autoestima. Lo mismo ocurre entre las variables autorreporte de Funcionamiento social de los ancianos y la Escala de Percepción de funcionamiento familiar-Apgar. Los resultados de esta investigación podrán ser considerados por los profesionales de salud para que en el trabajo con ancianos y sus familias se fomente la independencia, la funcionalidad y la calidad de vida.

As a part of the WHO Age-Associated Dementia Project, Chile has been participating in a cross-national survey on dementia frequency and determinants since 1989. In the present study, apolipoprotein E (ApoE) polymorphism genotypes have been compared in 95 patients with Alzheimer’s disease (AD) (mean age 80.7; 95% CI 79.2–82.2, range 66–97) and 187 healthy people (mean age 78.2; 95% CI 77.2–79.2, range 65–93). Isoelectric focusing and immunoblotting with anti-human ApoE polyclonal antibody were used to determine the distribution of ApoE genotypes. Dementia was diagnosed according to DSM-III-R and ICD-10 clinical criteria. The diagnosis of probable or possible AD was made according to the NINCDS-ADRDA criteria. The ApoE allele frequencies in healthy people were calculated to be σ2 = 0.07, σ3 = 0.74 and σ4 = 0.19. In the probable AD disease group, the frequencies were σ2 = 0.08, σ3 = 0.52 and σ4 = 0.40. The odds ratio (OR) for σ4 carriers compared with non-σ4 carriers was estimated to be 2.9 (95% CI 1.7–5.1). Taking the genotype σ3/σ3 as the reference group, the OR for the σ4/σ4 genotype was estimated to be 12.8 (95% CI 3.9–47.6) and for σ3/σ4 subjects it was 2.4 (1.3–4.5). These results support the association between ApoE σ4 allele with late-onset AD in a Chilean population.

There is an urgent need in multinational studies for efficient and sensitive tests for the evaluation of dementias. These tests are used to investigate the regional characteristics of dementias, providing possible insight into the different etiologies of the disorders. These tests are also utilized to assess the outcome of treatment interventions at multinational levels. We validated and standardized the Syndrom Kurztest, a brief European neuropsychological test, in a population of elderly Chileans, possessing high levels of illiteracy. In our sample, the SKT was found to be an effective instrument for the diagnosis of dementias, and for differentiating mild-moderate from severe degrees of the disease. There was a good correlation between the scores on the SKT and the age of the participants, but the gender and the years of schooling had no effect. The test is a useful contribution to the study of dementias, found in the aging developing world, particularly because it can be used in illiterate populations.

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