Physicians with specialty in geriatrics, psychiatry and neurology have not received training about the differential diagnosis of dementia, particularly regarding fronto-temporal dementia (FTD). Objective: To assess the level of knowledge of physicians about FTD. Material and Method: The survey was carried out during symposiums and scientific congresses from January 2016 to July 2017. Inclusion criteria: being a general practitioner or specialist in Geriatrics, Neurology and psychiatry whose training process as a physician and specialist has been carried out in Peruvian universities. We analyzed 217 surveys of which 13 were eliminated. The survey was divided into three parts, the first about general data of doctors, the second part was about the diagnosis of dementia; and the third on specific data of FTD. STATA version 12 was used for the statistical analysis. Results: 90% of the doctors surveyed were specialists in: Psychiatry (41.3%), Geriatrics artículo de investigación Recibido: 14/01/2017 Aceptado: 28/03/2018 Los autores no presentan ningún tipo de conflicto de interés. Financiamiento: El trabajo fue financiado por los autores.
Artículo de investigación Validación y precisión de la escala de deterioro global (GDS) para establecer severidad de demencia en una población de LimaValidation and diagnostic accuracy of the Global Deterioration Scale (GDS) ResumenObjetivo: validar y evaluar el rendimiento de la Global Deterioration Scale (GDS) en una población que acude a una unidad especializada de Lima. Pacientes y métodos: investigación de tipo transversal con un diseño descriptivo comparativo. El estudio incluyó 215 individuos seleccionados de forma abierta, que acudieron a la unidad de diagnóstico de deterioro cognitivo y prevención de demencia. Se estudiaron tres grupos: 60 controles, 40 con diagnóstico de deterioro cognitivo leve y 115 con demencia. Los individuos fueron sometidos a evaluaciones sucesivas: cribado, diagnóstico y estadiaje de demencia y tipo de demencia. La validez y fiabilidad de la clasificación de severidad fue demostrada mediante la concordancia entre la medición del Global Deterioration Scale con el Clinical Dementia Rating (CDR). El rendimiento de Global Deterioration Scale se valoró mediante la obtención de los valores de sensibilidad y especificidad. Resultados: los promedios de edad fueron de 69, 70, y 74 años para los controles, los pacientes con deterioro cognitivo leve y los pacientes con demencia, respectivamente. La Global Deterioration Scale tuvo una buena correlación con Clinical Dementia Rating (r de Spearman =0,97; P=0,0001). La sensibilidad de la escala para establecer estadio de demencia fue de 79 %, con especificidad del 100 % para cualquier categoría de demencia según los criterios diagnósticos estándares y según Clinical Dementia Rating. Conclusiones: se encontró una correlación casi perfecta entre Global Deterioration Scale y Clinical Dementia Rating; sin embargo, la Global Deterioration Scale presenta una sensibilidad moderada para establecer el estadio de demencia con respecto a Clinical Dementia Rating, mostrando además ser utilidad en el diagnóstico de deterioro cognitivo leve.Palabras clave: Global Deterioration Scale, Clinical Dementia Rating, Demencia, Escalas de estadiaje clínico de demencia. AbstractObjective: To validate and evaluate diagnostic accuracy of the Global Deterioration Scale (GDS) in a population of a specialized unit of Lima. Patients Comparte MEDICINACustodio N, Becerra-Becerra Yc, Alva-Diaz C, Montesinos R , Lira D, Herrera-Pérez E. Enero -Junio 2017 -Pág 15and Methods: This research is a comparative cross-sectional descriptive design. The study included 215 individuals selected openly, who attending in the diagnostic unit of cognitive impairment and dementia prevention. Three groups were studied: 60 controls, 40 individuals diagnosed with mild cognitive impairment (MCI) and 115 with dementia diagnosis. They were assessments in three phases: screening, diagnosis and staging of dementia and type of dementia. The validity and reliability of the classification of severity was demonstrated by measuring the correlation between the GDS with the CDR (Clinical Dementia Rating)....
RESUMENEl trastorno cognitivo vascular agrupa todas las instancias donde el compromiso cognitivo puede ser atribuido a enfermedad vascular cerebral, es mayor que el esperado para el envejecimiento normal y que, cuando llega a afectar las actividades de la vida diaria, se denomina demencia vascular. En esta revisión, se actualizan los términos relacionados a trastorno cognitivo vascular y se plantean estrategias de prevención y tratamiento basadas en revisiones sistemáticas y meta-análisis. En la primera parte se definen diversos términos relacionados a trastorno cognitivo vascular; en la segunda, se plantea el tratamiento del trastorno cognitivo vascular/demencia vascular, que incluye un manejo orientado a prevención primaria, controlando los factores de riesgo; un tratamiento secundario para prevenir la exacerbación o la extensión de las lesiones producidas por la injuria vascular cerebral y, finalmente,un tratamiento terciario o sintomático de los problemas cognitivos y/o conductuales. Damos especial énfasis y se fundamenta la conveniencia y beneficios de los tratamientos primario y secundario.PALABRAS CLAVE: Demencia, demencia vascular, prevención primaria, prevención secundaria, prevención terciaria, tratamiento. (Fuente: DeCS BIREME). SUMMARYVascular cognitive impairment is a label ascribed to cases in which the cognitive impairment can be attributed to cerebral vascular disease, is greater than the expected for normal aging and, when affecting the activities of daily life, is called vascular dementia. In this review, the terms related to vascular cognitive impairment, are updated, and strategies for prevention and treatment, based on systematic reviews and meta-analyses are outlined. In the first part, various vascular cognitive impairment-related terms are defined; in the second part, the treatment of vascular cognitive impairment / vascular dementia is described: it includes, management steps oriented towards primary prevention, controlling risk factors; a secondary treatment aimed at the prevention of exacerbation or extension of lesions produced by the vascular brain injuries and, finally, the tertiary or symptomatic treatment of cognitive and
Introduction: To evaluate the diagnostic accuracy of three brief cognitive screening (BCS) tools, Peruvian version of Addenbrooke's Cognitive Examination (ACE-Pe), of INECO Frontal Screening (IFS-Pe) and of the Mini-Mental State Examination (MMSE-Pe), for the diagnosis of vascular cognitive impairment (VCI) and its nondementia stages (VCI-ND) and vascular dementia (VD) in patients with cerebral stroke in Lima-Peru. Materials and methods:A cohort analysis to evaluate the diagnostic accuracy of three BCS for VCI.Results: Two hundred and four patients were evaluated: 61% Non-VCI, 30% VCI-ND and 9% VD. To discriminate patients with VCI from controls, the area under the curve (AUC) of ACE-Pe, IFS-Pe and MMs-Pe were 0.99 (95% confidence interval [CI] 0.98-0.99), 0.99 (95%CI 0.98-0.99) and 0.87 (95%CI 0.82-0.92), respectively. Of the three BCS, the IFS-Pe presented a larger AUC to discriminate VCI-ND from VD (AUC = 0.98 [95%CI 0.95-1]) compared to ACE-Pe (AUC = 0.84 [95%CI 0.74-0.95]) and ). The IFS-Pe presented a higher sensitivity (S), specificity (Sp), and positive (+LR) and negative likelihood ratios (−LR) (S = 96.72%, Sp = 89.47%, +LR = 9.1 and −LR = 0.03) than ACE-Pe (S = 96.72%, Sp = 63.16%, +LR = 2.62 and −LR = 0.05) and MMSE-Pe (S = 90.16%, Sp = 78.95%, +LR = 4.28 and −LR = 0.12). In the multiple regression analysis, the IFS-Pe was not affected by age, sex or years of schooling. Conclusion:The IFS-Pe has the best diagnostic accuracy for detecting VCI and discriminating between pre-dementia (VCI-ND) and dementia (VD) stages.
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